Mazzucchi Edoardo, La Rocca Giuseppe, Cusumano Davide, Bazzu Paola, Pignotti Fabrizio, Galieri Gianluca, Rinaldi Pierluigi, De Santis Vincenzo, Sabatino Giovanni
Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy.
Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.
Front Psychol. 2023 Mar 22;14:1070205. doi: 10.3389/fpsyg.2023.1070205. eCollection 2023.
Pre-operative psychological factors may influence outcome after spine surgery. The identification of patients at risk of persisting disability may be useful for patient selection and possibly to improve treatment outcome.
Patients with neurogenic claudication associated with degenerative lumbar spinal stenosis (DLSS) performed a psychological assessment before lumbar decompression and fusion (LDF) surgery. The following tests were administrated: Visual Analogic Scale; Symptom Checklist-90 (SCL-90-R), Short Form-36 and Oswestry Disability Index (ODI). The primary outcome was ODI score lower than 20. A cross correlation matrix (CCM) was carried out with significant variables after univariate analysis and a linear logistic regression model was calculated considering the most significant variable.
125 patient (61 men and 64 women) were included in the study. Seven parameters of the SCL-90-R scale showed statistical significance at the univariate analysis: obsessivity ( < 0.001), Current Symptom Index ( = 0.001), Global Severity Index ( < 0.001), depression ( < 0.001), positive Symptom Total ( = 0.002), somatization ( = 0.001) and anxiety ( = 0.036). Obsessivity was correlated with other significant parameters, except GSI (Pearson's correlation coefficient = 0.11).The ROC curve for the logistic model considering obsessivity as risk factor, has an area under the curve of 0.75.
Pre-operative psychopathological symptoms can predict persistence of disability after LDF for DLSS. Future studies will evaluate the possibility of modifying post operative outcome through targeted treatment for psychological features emerged during pre-operative assessment.
术前心理因素可能会影响脊柱手术后的结果。识别有持续残疾风险的患者可能有助于患者的选择，并可能改善治疗结果。
患有与退行性腰椎管狭窄症（DLSS）相关的神经源性间歇性跛行的患者在进行腰椎减压融合术（LDF）之前进行了心理评估。进行了以下测试：视觉模拟量表；症状自评量表90（SCL-90-R）、简明健康状况调查量表（SF-36）和奥斯威斯利功能障碍指数（ODI）。主要结果是ODI评分低于20。在单因素分析后，对显著变量进行了交叉相关矩阵（CCM）分析，并考虑最显著变量计算了线性逻辑回归模型。
125名患者（61名男性和64名女性）纳入研究。SCL-90-R量表的七个参数在单因素分析中显示出统计学意义：强迫观念（<0.001）、当前症状指数（=0.001）、总体严重程度指数（<0.001）、抑郁（<0.001）、阳性症状总分（=0.002）、躯体化（=0.001）和焦虑（=0.036）。除总体严重程度指数外，强迫观念与其他显著参数相关（皮尔逊相关系数=0.11）。将强迫观念作为危险因素的逻辑模型的ROC曲线下面积为0.75。
术前心理病理症状可预测DLSS患者LDF术后残疾的持续情况。未来的研究将评估通过针对术前评估中出现的心理特征进行有针对性的治疗来改善术后结果的可能性。
