gms | German Medical Science

Objective: It is well known that the chronification of spinal patients depends more on psychosocial factors than purely on the intensity of the disease. Until now, very little data exists on the psychic strain and comorbidity of patients with spinal surgery in correlation to their clinical outcome.

Method: From 2006 until today every patient of our outpatient clinic, who decided to have a spinal operation received the following standardized, clinically validated questionaires: Beck's Depression Inventory (BDI; Beck, Ward, Mendelson, Mock & Erbaugh, 1961), the Gießen Physical Complant List (GBB-24; E. Brähler, A. Hinz, J.W. Scheer) and a third questionnaire often used in research on fibromyalgia. In addition a history was conducted in two subgroups and their clinical results 4 years after surgery were correlated with their praeoperative psychic status.

Results: 1678 (68%) of the 2480 patients filled in the questionnaires. Out of these, only complete questionnaires with no item missing were taken into account, resulting in the response rate. In a first step we present the data of the praeoperative psychic condition of the patients. Secondly, for a small sample of 100 patients with cervical prosthesis and another 100 patients having lumbar fusion surgery, we gathered data and correlated the clinical results 4 years after surgery with the initial stress values, receiving a response rate of either 85% or 80%. According to the results using the Beck Depression Inventory, 9% of our spine patients show clinically relevant symptoms and 24% show mild depressive symptoms, whereas according to statistics of the Robert Koch Institut (2006) the prevalence of depression in Germany is 7,8% for women and 4,8% for men respectively. Only 67% of our patients had normal test scores. Since 37% of the female and 39% of the male spine patients had symptoms, the quartile of the GBA presenting the highest degree of psychic stress contains far more patients than the 25% that could be expected in the normal population. Correlations between the test scores and the clinical status were calculated using Spearman's rho and Kendall's tau. Values from -0.12 to +0.38, were not statistically significant.

Conclusions: First dependable data on the psychic condition of a large population of patients undergoing spinal surgery are presented. Correlations with clinical results after four years show little significance. The outcome of patients with cervical prothesis seems to be more influenced by psychic problems than that of lumbal fusion patients.