Information for Physicians
Spine Surgery and Implants: Pre-operative Psychological Assessment
Spine surgery and spinal implants (spinal cord stimulators and implantable drug systems) can result in improved functionality, reduced pain, decreased medication use, and return to work. However, pathology alone may be an insufficient predictor of outcome from spine surgery or spinal implants. Non-medical factors including psychological risk factors can have a potent effect on surgical success and post-operative management.
The Occupational Medicine Practice Guidelines (ACOEM, 2004) emphasize that physicians should consider psychological evaluation as part of the surgical pre-screening process. Many carriers systematically require psychological screening prior to surgical authorization. Obtaining psychological evaluation prior to requesting authorization for spinal procedures may streamline the utilization review timeline and minimize delays.
Our evaluation protocol relies on empirical research on psychological factors in surgical and/or pain populations. We translate the clinical data we obtain into an algorithm for characterizing the level of psychosocial risk. We then make specific recommendations for remediating expectations, enhancing compliance, encouraging participation in rehabilitation, and addressing untreated psychopathology.
The evaluation consists of a clinical interview, validated psychological testing, and a review of the patient’s medical records. The comprehensive assessment examines issues including substance abuse, psychosocial support, pre-injury functioning, pain sensitivity, somatization, anxiety, depression, and personality factors.
We are able to schedule most patients for evaluation within two weeks of the referral. We can usually complete the evaluation and provide the physician and/or the insurance carrier a full report within five working days.
Some patients benefit from additional psychological input prior to spinal surgery to increase their prognosis for surgical success. We are available on an hourly basis for cognitive-behavioral input on a number of relevant topics to enhance outcome. Surgical preparation can include cognitive restructuring, behavioral programming, psychological pain management, and rallying psychosocial support. Post-operative psychological input includes activity scheduling, modification of maladaptive beliefs, anticipating pain “relapses,” and reframing the interpretation of disability. We can also provide referrals for psychiatric input and vocational rehabilitation.