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Assessment of Presurgical Psychological Screening in Patients Undergoing Spine Surgery: Use and Clinical Impact

Young, Arthur K. BA; Young, Benjamin K. BS, MS; Riley, Lee H. III MD; Skolasky, Richard L. ScD

Journal of Spinal Disorders and Techniques: April 2014 - Volume 27 - Issue 2 - p 76–79
doi: 10.1097/BSD.0b013e31827d7a92

Study Design: Prospective survey.

Objective: To determine the prevalence of use of presurgical psychological screening (PPS) among spine surgeons in the United States, identify factors associated with PPS use, evaluate surgeons’ opinions of PPS, and investigate how PPS is applied in clinical practice.

Summary of Background Data: The United States Preventive Services Task Force recommends PPS for patients undergoing back surgery. The prevalence of PPS is unknown. Thus, it may be difficult to improve preoperative care for such patients with psychological conditions.

Methods: An online survey invitation was emailed to 340 spine surgeons. Questions addressed surgeon characteristics (eg, number of years in practice), practice characteristics (eg, practice type), inclusion of integrated rehabilitation and psychological services, and use of PPS. The impact of psychological factors on rehabilitation and recovery was assessed using an 11-point Likert scale (0, no impact; 10, highest impact). We analyzed the 110 (32%) responses with a χ2 test (significance, P<0.05).

Results: PPS was used by 37% (41) to screen for depression (100%) or anxiety (85%). PPS use was highest among surgeons with more experience, higher annual volume, and no university affiliation. Among those screening for fear avoidance, use was highest among surgeons more recently entering the field. Surgeons reported a strong belief regarding the impact of psychological factors on pain relief, adherence to therapy, and return to work (mean impact rating, >7.0); however, impact on return for follow-up was only moderate (mean rating, 5.8).

Conclusions: A minority of surgeons reported using PPS. Surgeons were less likely to use PPS if they had completed residency or begun practice within 14 years, had fewer than 200 cases annually, or were university affiliated. This study highlights the need to advocate for the use of North American Spine Society guidelines regarding the use of PPS.

Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD

Supported by The Johns Hopkins’ Provost’s Undergraduate Research Award.

The authors declare no conflict of interest.

Reprints: Richard L. Skolasky, ScD, c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, 4940 Eastern Ave., #A665, Baltimore, MD (e-mail:

Received April 26, 2012

Accepted November 9, 2012

© 2014 by Lippincott Williams & Wilkins, Inc.