Childhood psychological trauma correlates with unsuccessful lumbar spine surgery.
In a retrospective study of 86 patients who underwent lumbar spine surgery, patients who had three or more of a possible five serious childhood psychological traumas (risk factors) had an 85% likelihood of an unsuccessful surgical outcome. Conversely, in patients with a poor surgical outcome, the incidence of these traumas was 75%. In the group of 19 patients with no risk factors, there was only a 5% incidence of failure. This study shows that a highly significant correlation exists between unsuccessful lumbar spine surgery and a history of childhood traumas. Although recognition of predictors for unsuccessful outcome can be useful in avoiding surgery in patients whose indications for surgery are borderline, the greater challenge is to help the patient who, despite being at high psychological risk for negative outcome, has severe spinal pathology that will likely require surgery. In such cases, psychiatric treatment is critical. In the group of 19 patients with no risk factors, single-level laminectomies and discectomies were performed on 6 patients. The other 13 cases were complex, involving a combination of repeat surgeries (n = 4) fusions (n = 3), and/or multilevel laminectomies and discectomies (n = 11).
Schofferman
J
J
San Francisco Spine Institute, Daly City, California.
Anderson
D
D
Hines
R
R
Smith
G
G
White
A
A
D000328:Adult; D001416:Back Pain / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery*; D008950:MMPI; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome