Schofferman J, Anderson D, Hines R, Smith G, White A
San Francisco Spine Institute, Daly City, California.
Spine (Phila Pa 1976). 1992 Jun;17(6 Suppl):S138-44. doi: 10.1097/00007632-199206001-00013.
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).
在一项对86例行腰椎手术患者的回顾性研究中，在可能存在的5种严重童年心理创伤（风险因素）中，有3种或更多创伤的患者手术结果不成功的可能性为85%。相反，手术结果不佳的患者中，这些创伤的发生率为75%。在19例无风险因素的患者组中，失败发生率仅为5%。这项研究表明，腰椎手术不成功与童年创伤史之间存在高度显著的相关性。尽管识别手术结果不佳的预测因素有助于避免对手术指征不明确的患者进行手术，但更大的挑战是帮助那些尽管手术结果出现负面心理风险很高，但患有严重脊柱病变可能需要手术的患者。在这种情况下，精神科治疗至关重要。在19例无风险因素的患者组中，6例患者进行了单节段椎板切除术和椎间盘切除术。其他13例情况复杂，包括再次手术（4例）、融合术（3例）和/或多节段椎板切除术和椎间盘切除术（11例）的组合。
