The Impact of Preoperative Psychological Interventions on Postoperative Outcomes in Spine Surgery: A Systematic Review

Introduction: Patients with back pain are at a higher risk for worse mental health symptoms due to physical pain and impaired quality of life. Surgery can exacerbate this, often leading to poorer postoperative outcomes. While the impact of psychiatric burden on spine surgery patients has been well-studied, research on psychological interventions is limited. The literature has been reviewed for cognitive behavioral therapy in lumbar surgery, however this study aims to evaluate the broader impact of preoperative psychological interventions across all spine surgeries on postoperative outcomes.

Methods: We searched MEDLINE, EMBASE, and Scopus from database inception through August 6th, 2024. Keywords and subject headings represented the concepts of adult spine surgery, preoperative psychological intervention and postoperative outcomes. Studies were screened by title and abstract and texts were evaluated against eligibility criteria. Review stages were conducted independently by two reviewers.

Results: A total of 4,999 studies were identified initially, yielding 13 studies with 9,316 patients to analyze. Three studies involved patients undergoing ACDF, four lumbar spinal fusion, three lumbar laminectomy and discectomy, and three unspecified spine surgeries. Seven studies analyzed pharmacotherapy as the preoperative intervention, including SSRIs, benzodiazepines, and pregabalin. Three studies focused on relaxation, mindfulness, or music therapy, and three specifically examined cognitive behavioral therapy. Nine studies reported on pain outcomes, with seven showing statistically significant lower postoperative pain compared to control groups. Six studies assessed postoperative disability, with four showing significant reductions in disability for those receiving interventions. Five studies analyzed anxiety levels, with four reporting significant improvements. A few isolated studies showed similar positive effects on length of stay and mobility.

Conclusion : This study highlights that there is a small portion of studies within spine surgery that have analyzed preoperative interventions and their outcomes. There were statistically significant positive effects on outcomes across modalities, improving pain, disability and psychological symptoms, among others. Although understudied, this study suggests that preoperative psychological interventions of various modalities can improve postoperative outcomes in spine surgery patients, with further studies needed to identify optimal timing.