Significant psychological and functional improvement following surgical treatment of lumber spondylosis

Abstract

Study design This is a retrospective cohort study. Objective The objective of this study is to investigate the incidence of preoperative functional impairment, anxiety and depression in patients presenting for spinal surgery and the effect of surgery on medium term on functional and psychological parameters. Summary of background data Psychological factors may predispose individuals to the development of chronic back pain and also predict the outcome of lumbar surgery, and validated psychological screening tests have previously been applied in the evaluation of spinal disorders. Methods Patients admitted for decompressive lumbar surgery over a 3-year period were evaluated pre- and postoperatively with the Oswestry Disability Index and the Hospital Anxiety and Depression Score. These scores were audited to assess functional benefit following surgery. Results Fifty-three patients had sufficient data for inclusion. Preop and postop scores were compared to evaluate the psychological and functional outcomes, using a one-tailed t test for statistical analysis. Preoperative radiology revealed disc prolapse in 43 patients (predominantly L5), and 7 patients were found to have degenerative spinal stenosis. Twenty-two patients underwent discectomy and 30 patients combined discectomy and decompression. Functional disability was significantly improved in patients undergoing surgery, with higher scores in 79% of patients. Surgery resulted in a significant benefit on depressive scores but not anxiety scores. Outcomes were better in discectomy than stenosis, and with early (< 6 months) surgery. Conclusions Our study quantifies the psychological burden of lumbar spinal disease and demonstrates that pain relief following nerve root decompression in particular has a significant benefit on both physical function and psychological distress.