Evaluation of psychosomatic distress and its influence in the outcomes of lumbar fusion procedures for degenerative disorders of the spine.

The authors aim to evaluate the ability of spine surgeons to subjectively identify patients with psychological distress in a subset of lumbar fusion candidates, and the influence of such factors on surgical outcomes. From a cohort of 85 patients who had received a surgical indication for lumbar fusion and were subjectively evaluated for psychological distress, 60 were included in the study and underwent objective evaluation using the Distress Risk Assessment Method (DRAM) evaluation for depressive/distress symptoms, VAS and Oswestry scores pre- and postoperatively. Fifty-six patients were available with a minimum 6-month follow-up: 20 presented with normal DRAM scores, and 36 with abnormal DRAM (28 at risk; 4 distressed somatic; 4 distressed depressive). Although the group improved significantly with surgery regarding VAS and Oswestry, it was not the case for the DRAM score. The abnormal DRAM group had inferior VAS, Oswestry and satisfaction rates in comparison with the normal DRAM group. A significant number of patients in the at-risk group reduced their DRAM scores and were classified as normal patients at the end of the study. This study emphasizes the need for objective psychological screening on chronic low back pain patients and that although patients with abnormal DRAM scores benefit from surgery, they report inferior outcomes and satisfaction in comparison with the normal DRAM group.