Time course and correlates of psychological distress post spinal surgery: A longitudinal study

June Mei Tse Quek; Joy Tan; Irene Toh; John Li-Tat Chen; William Yeo; Yong-Hao Pua

doi:10.1016/j.xnsj.2023.100277

Time course and correlates of psychological distress post spinal surgery: A longitudinal study

N Am Spine Soc J. 2023 Sep 14:16:100277. doi: 10.1016/j.xnsj.2023.100277. eCollection 2023 Dec.

Authors

June Mei Tse Quek¹, Joy Tan¹, Irene Toh², John Li-Tat Chen³, William Yeo³, Yong-Hao Pua^{1

4}

Affiliations

¹ Department of Physiotherapy, Singapore General Hospital, Outram Road, Singapore 169608.
² Allied Health Centre of Excellence, The National Trades Union Congress Health Co-Operative Ltd., Singapore, 5 Ubi Ave 1, #08-01, Singapore 408935.
³ Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
⁴ Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore General Hospital, Outram Road, Singapore 169608.

Abstract

Background: Psychological distress post lumbar spine surgery is associated with poorer outcomes. There is a scarcity of studies devoted to analyzing the risk factors associated with psychological distress in patients who have undergone lumbar fusion surgery. The purpose of this study was to (1) describe the time course and severity of psychological distress using the STarT Back Tool (SBT) and (2) determine the demographic and clinical predictors of SBT score post lumbar spine fusion surgery.

Methods: This retrospective longitudinal study analyzed 227 subjects with 1- and 2-level lumbar fusion surgery who underwent standardized assessment preoperatively and at 4 and 12 weeks postoperatively. Preoperative variables collected were demographic, clinical, and psychological variables. Postoperative psychological distress was measured by self-reported SBT. Risk factors for SBT over time were identified using ordinal and mixed-effects modelling.

Results: Although the trajectory of SBT levels declined postoperatively over time, at week-12, 20% of patients had moderate to high SBT. Postoperative SBT scores at week-4 time point was significantly greater than SBT scores at week-8 (OR = 2.7, 95% credible interval [CrI]; 1.8-3.9). Greater SBT scores at week-4 were strongly associated with greater SBT scores throughout 12 weeks of follow-up (OR = 7.3, [95% CrI; 1.2-31.4]). Greater postoperative SBT levels over time were associated with being male (OR = 2.2, 95% CrI; 1.0-3.9), greater preoperative back or leg pain intensity (OR = 2.2; 95% CrI: 1.0-4.4), greater preoperative leg weakness (OR = 4.2, 95% CrI: 1.7-7.5) and higher preoperative depression levels (OR = 4.8; 95% CrI: 1.6-10.4).

Conclusion: Postoperative SBT levels declined nonlinearly over time. However, a sizable proportion of patients had moderate to high psychological distress at week-12 postsurgery. Greater preoperative back or leg pain intensity, leg weakness and depression levels, and male gender were risk factors of greater psychological distress postsurgery. Although requiring validation, our study has identified potential modifiable risk factors which may give an opportunity to provide early (preoperative) and targeted strategies to optimize postoperative psychosocial outcomes in patients undergoing lumbar fusion surgeries.

Keywords: Longitudinal; Lumbar fusion; Postoperative outcomes; Preoperative predictors; Psychological distress; Risk factors; STarT Back Tool.