The role of psychopathological symptoms in lumbar stenosis: A prediction model of disability after lumbar decompression and fusion

Edoardo Mazzucchi; Giuseppe La Rocca; Davide Cusumano; Paola Bazzu; Fabrizio Pignotti; Gianluca Galieri; Pierluigi Rinaldi; Vincenzo De Santis; Giovanni Sabatino

doi:10.3389/fpsyg.2023.1070205

The role of psychopathological symptoms in lumbar stenosis: A prediction model of disability after lumbar decompression and fusion

Front Psychol. 2023 Mar 22:14:1070205. doi: 10.3389/fpsyg.2023.1070205. eCollection 2023.

Authors

Edoardo Mazzucchi^{1

2}, Giuseppe La Rocca^{1

2}, Davide Cusumano³, Paola Bazzu⁴, Fabrizio Pignotti^{1

2}, Gianluca Galieri^{1

2}, Pierluigi Rinaldi⁵, Vincenzo De Santis⁵, Giovanni Sabatino^{1

2}

Affiliations

¹ Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy.
² Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.
³ Unit of Medical Physics, Mater Olbia Hospital, Olbia, Italy.
⁴ Clinical Psychology Service, Mater Olbia Hospital, Olbia, Italy.
⁵ Unit of Radiology, Mater Olbia Hospital, Olbia, Italy.

Abstract

Introduction: 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.

Methods: 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.

Results: 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 (p < 0.001), Current Symptom Index (p = 0.001), Global Severity Index (p < 0.001), depression (p < 0.001), positive Symptom Total (p = 0.002), somatization (p = 0.001) and anxiety (p = 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.

Conclusion: 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.

Keywords: anxiety; bio-psychosocial model; depression; lumbo-sacral instrumentation; minimally invasive spine surgery; obsessivity.