Are you ready for spine surgery? While you are weighing the risks and benefits of the procedure, don’t forget to consider the psychological impact your surgery may have. As your spinal surgery approaches, you have likely considered your physical post-surgical needs such as prepared meals, slip on shoes, and a toilet riser (See Preparation Before Back Surgery). These preparations will help you as you heal from your surgery physically, but preparing for the possible emotional and psychological toll of surgery can be just as important.
Oregon Health and Science University Study
Research shows that the better prepared a patient is physically and psychologically before surgery, the better the outcomes. A recent study published in the journal Spine and conducted by the Oregon Health and Science University (OHSU) determined that one in five spine surgery patients develop Post Traumatic Stress Disorder (PTSD) after having a low back fusion surgery.1
PTSD is typically associated with war veterans or victims of sexual assault, but a growing body of evidence suggests that cardiac surgery and surgery after a trauma (like a car accident) - and now the new spine surgery study - is associated with PTSD in some patients.
Author of the study, Robert Hart, M.D., stated, "It is maybe not surprising that significant surgical interventions have psychological as well as physical impacts. I think it means that we in the medical community need to monitor for these effects in our patients and to manage them when they occur."1
Ramifications of PTSD
Following a traumatic event, PTSD sufferers may have recurrent or intrusive memories or dreams of the event. Situations that remind the person of the trauma may invoke intense fear, and some sufferers may even forget certain details of their experience.
This can all lead to social isolation, loss of interest in usual activities, a restricted range of feelings, negative body image, suicidal thoughts and tendencies, and a general lower quality of life. MRIs and PET scans show that the brain actually undergoes specific physical changes in patients with PTSD.2
Weighing the Risks
This all sounds very scary if you are a patient considering spinal fusion surgery. How do you protect yourself from this possible outcome? Is the benefit of surgery worth the risk of developing PTSD?
According to the OHSU study, one of the best indicators of whether or not a patient will develop PTSD after spinal fusion surgery is if the patient has a pre-existing psychiatric disorder, such as anxiety or depression. In general, patients who have already had a traumatic experience in their life are also more likely to develop PTSD after a second traumatic event.3
If you do have depression or anxiety, or if you have already experienced a traumatic event in your life, be sure to discuss this with your doctor. Some preventive pre-surgery therapy may significantly improve your emotional outcome.
According to psychologist Dr. Deardorff, studies have historically found that the more a patient knows and understands about his or her surgery, the better the outcomes. Some people need more information than others, depending on their personality styles. (For more information see his article How to Prepare Psychologically for Back Surgery)
Get the Support You Need
Make sure you have all the support you will need; physically, intellectually, emotionally, and mentally, to give yourself the best chance of avoiding PTSD.
The good news for patients suffering from PTSD is that there are therapies and good practices that can help. Eating healthy, exercising, maintaining the support of family and friends, and learning to ask for help when you need it all ease the symptoms of PTSD. Most symptoms disappear within a year.
What is the bottom line? You and your doctor should discuss whether or not you are at high risk for developing PTSD, and if the risk of spine fusion surgery will outweigh the benefit.
- Deisseroth, K, Hart RA, "Symptoms of Post-traumatic Stress Following Elective Lumbar Spinal Arthrodesis," Spine,2012 Aug 15;37(18):1628-33, accessed via PubMed.
- Bremner JD, Randall P, Scott TM, et al, "MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder," American Journal of Psychiatry, 1995 Jul; 152(7):973-81, accessed via PubMed.
- Cleveland Clinic website