We introduced you to Clinical Health Psychologist William W. Deardorff, PhD, ABPP in last week’s blog post, The Psychology of Pain Blog Series: 1.

Considering spine surgery for a herniated disc? You may want to talk to a psychologist first to make sure it's the right decision. Watch: Herniated Disc Video

This week I asked Dr. Deardoff to elaborate on who should consult a psychologist before they have spine surgery.

See How to Prepare Psychologically for Back Surgery

Veritas Health:

Who do you recommend undergo a pre-surgical psychological screening before spine surgery?

Dr. Deardorff:

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.).

See When Back Pain May Be a Medical Emergency

Cauda Equina Syndrome is considered an emergency. Watch: Cauda Equina Syndrome Video

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.

See Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain after Surgery


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.

See Treatment Options for Pain After Back 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.).

See Preparation Before Back Surgery

Patients having surgery based on a physical finding such as a fracture may not need pre-surgical pscyhological screening. Watch: Spinal Compression Fracture Video

Another case for pre-surgical psychological screening is when there is a low correlation between the diagnostic study findings (MRI, CT, EMG, etc.) and the pain complaints.

See Important Considerations for an MRI Scan

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.

Learn more:

Benefits of Psychological Preparation for Back Surgery

Cognitive Techniques to Prepare for Back Surgery