The Relationship Between Social-psychological Factors And Lumbar Surgery Outcome

ObjectiveThe study examined whether social-psychological factors predict several surgical outcomes.Study patients completed measures of social-psychological distress Questionnaire before surgeryto compare the lumbar surgery outcome of the patients with emotional distress with the patientswithout emotional distress to analyze the relationship between preoperative social-psychologicalfactors and lumbar surgical outcomes. For the orthopaedist use of presurgicalsocial-psychologica screening to predict the outcome of spine surgery more comprehensive. Onthe other hand, it can provide the evidence of psychological intervention to patients forimproving the effects of the operations and avoid the occurrence of medical disputes.And thenthe patients will have a positive attitude in life and work.MethodsBetween the October1,2010and October1,2012,there are94patients who will undergo theoperations of lumbar disc herniation,lumbar spinal stenosis、or spondylolisthesis and fixationand fusion by the same group of orthopedics at ZhuhaiPeople’s Hospital.We can group thepatients with different psychological factors according to SCL-90self-rating scale,Self-RatingAnxiety Scale, Self-Rating Depression Scale and Cook-Medley hostility scale preoperatively.Patients who SCL-90psychological symptom checklist score were less than160points andthe number of positive items was less than43,were grouped to the normal group;Patients whoSelf-Rating Anxiety Scale were greater than or equal to50points were group to the anxietygroup, Patients who Self-Rating Depression Scale were greater than or equal to50pointsattributed to the depression group; Patients who Cook-Medley hostility scale were greater than orequal to30points were group to the hostile groups; Patients who Self-Rating Anxiety Scalewere greater than or equal to50points and Cook-Medley hostility scale were greater than orequal to30points were grouped to the anxiety hostile groups. In3months and6monthspostoperative, all patients were graded respectively according to "ODI" and "VAS". At last, the function improvement rate and pain improvement rate of all patients withlumbar spine surgery were counted to observe the relationship between social-psychologicalfactors and lumbar surgical outcomes.Improvement rate=[(pre-treatment scores-scores after treatment)/pre-treatment score]×100%.Results1、 Comparison the normal group with the anxiety group,P=0.001(P <0.05) it can beconsidered normal postoperative functional improvement rate high than the anxiety group.2、Comparison the normal group with the depression group, P=0.000(P <0.05)it can beconsidered normal postoperative functional improvement rate high than the depression group.3、By the number of samples between any two of SNK test, α=0.05level, it can be considerednormal group postoperative pain improvement rate high than the anxiety group and thedepression group.4、The relationship between the score of anxiety and postoperative functional improvementrate。The component of the linear regression statistical have significance。χ~2=9.89, P=0.002(P <0.05). Postoperative functional improvement rate increase with the level of anxiety scoresreduced.5、The relationship between the score of anxiety and postoperative pain improvement rate。Thecomponent of the linear regression statistical is significance。χ~2=8.775, P=0.003(P <0.05).The rank correlation coefficient was0.287(p=0.005). Postoperative pain improvement ratedecreases with the increase in the level of anxiety score.6、The relationship between the score of depression and postoperative functional improvementrate。The component of the linear regression statistical have significance。χ~2=8.347, P=0.004(P <0.05). Postoperative functional improvement rate increase with the level of depression scoresreduced.7、The relationship between the score of depression and postoperative pain improvement rate。The component of the linear regression statistical is significance。χ~2=9.108, P=0.003(P <0.05).Postoperative pain improvement rate decreases with the increase in the level ofdepression scores.8、Comparison the normal group with the hostile group, P=0.714(P>0.05)， have nostatistically significant it can not be considered normal postoperative function improvement rateand pain function improvement rate better than the hostile group。Conclusion1、Preoperative depressive symptoms and anxiety symptoms is a common factors in spinalsurgery patients。Preoperative depressive symptoms and anxiety symptom may indicate thosepatients at greater risk for poor lumbar surgery outcome.2、Patients with hostility symptoms did not predict at greater risk for poor lumbar surgeryoutcome，but patients with either hostility symptoms or anxiety symptoms is at greater risk forpoor lumbar surgery outcome.3、The evaluation of psychological factors should be carried out, during preoperative stages.Psychological intervention before and after lumbar spine surgery, anti-anxiety andanti-depression treatment has great significance to improve the effects of this type of lumbarsurgery in patients with severe anxiety symptoms and depression symptoms.