This week I asked Dr. Deardoff to elaborate on who should consult a psychologist before they have spine surgery.
Who do you recommend undergo a pre-surgical psychological screening before spine surgery?
99% of all spine surgeries are elective. In other words, surgery is a choice made by the patient and spine surgeon. The other 1% are truly medically necessary to treat (spinal tumors, cauda equina, etc.).
A pre-surgical psychological screening (PPS) can help with the decision making in this 99% group.
A pre-surgical psychological screening will most often be recommended by the careful spine surgeon in appropriate cases; however, this does not always occur. Not all spine surgeries require pre-surgical psychological screening, just those in which risk factors for a poor clinical outcome are high.
Most spine surgeries these days are technically successful (the anatomical problem is fixed) but that does not mean they will be clinically successful. In other words, the patient may still feel pain after the surgery.
A pre-surgical psychological screening might generally be recommended when the surgery is more extensive (e.g. a fusion) and is directed primarily at pain relief versus other physical findings (spine instability, fracture, foot drop,incontinence, weakness, etc.).
When there is more pain being experienced than can be explained by the diagnostic studies, or the pain is not in the correct place relative to the studies, then a pre-surgical psychological screening is indicated. In these cases, the surgeon might say, “Well, there are some findings here but they don’t explain why you are having so much pain and in so many areas.”
Other more overt risk factors suggesting a pre-surgical psychological screening should be done include:
- One or more previous spine surgeries that failed
- Long-term pain medication use
- Substance use/abuse issues
- Long term disability from work
- Significant psychological issues such as clinical depression or anxiety
Many thanks to Dr. Deardorff for helping us shed light on the importance of considering the psychological aspects of spine surgery. Next week we'll ask Dr. Deardorff some more practical questions about how to find the right psychologist for pre-surgical screening and how your psychologist can help you if you are not a good surgical candidate.