184. Psychological distress in patients undergoing cervical spine surgery: two-year outcomes of a randomized controlled trial

Abstract

<h3>BACKGROUND CONTEXT</h3> Recent studies have suggested that in patients with neck pain, both psychological and physical symptoms need to be addressed. Cognitive behavioral therapy (CBT) works to address risk factors through education about pain, modification of maladaptive beliefs, and increasing patient's self-efficacy. <h3>PURPOSE</h3> To determine the long-term effectiveness of brief psychological intervention on psychological outcomes in cervical spine surgery. <h3>STUDY DESIGN/SETTING</h3> Prospective, blinded, and placebo-controlled trial. <h3>PATIENT SAMPLE</h3> Forty-eight patients undergoing cervical spine surgery. <h3>OUTCOME MEASURES</h3> Fear Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), Neck Disability Index (NDI), modified Japanese Orthopedic Association (mJOA), visual analog scale (VAS), EuroQol Five Dimensions (EQ5D), Numeric Rating Scale (NRS) for neck and arm pain. <h3>METHODS</h3> To date, 48 patients age >18yrs with symptomatic cervical degenerative disease have been enrolled in the RCT. All patients underwent elective cervical surgery of ≤5 levels, and had an NDI >20%. Patients who met psychological distress criteria [DRAM >17 and <33, FABQ >49 and <66, PCS >30 and <52, or OEQ ≤2] were randomized to a treatment group (CBT or placebo [Sham]). Patients exceeding these criteria were assigned to the DRAM Observational group. The remaining patients were considered controls. CBT and Sham treatment groups each received 6 sessions prior to surgery. The Control and DRAM Observational groups had no intervention prior to surgery. Baseline (BL) to 2-year (2Y) changes in HRQLs were assessed by randomization group. <h3>RESULTS</h3> A total of 48 patients enrolled (53.6yrs±10.7yrs, 49% female, 29.6±5.9kg/m2), and underwent surgical correction (levels fused 2.2±1.5, EBL: 111mL, operative time: 177min). By surgical approach, 80% underwent anterior-only, 16% posterior-only, and 4% combined. By randomization group: 17 (35.4%) CBT, 12 (25.0%) Sham, 10 (20.8%) Control, and 9 (18.8%) DRAM. All patients had HRQL data collected preoperatively; 33 patients (68.8%) completed 2Y follow-up. Overall, the following number of patients improved from BL to 2Y in each HRQL: PCS – 21, FABQ – 16, mJOA – 18, NDI – 24, EQ5D – 17, VAS – 21, NRS Neck – 20, NRS Arm – 21 patients. Univariate analysis showed that patients in the CBT group trended toward a higher rate of improvement in PCS (56% vs other groups: 41%, p=0.338), FABQ (50% vs 28%, p=0.133), NDI (69% vs 45%, p=0.124), EQ5D (50% vs 31%, p=0.209), VAS (63% vs 38%, p=0.114), NRS Neck (56% vs 38%, p=0.236), and NRS Back (63% vs 38%, p=0.114). These trends were maintained when comparing the CBT group with each of the Control, Sham, or DRAM Observational groups individually. <h3>CONCLUSIONS</h3> While limited by sample size, clear trends in our cohort of operative cervical spine patients show that improved psychological and functional outcomes may be achieved with preoperative CBT intervention. Further investigation is warranted to validate these findings. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.