Abstract
Introduction
Back pain is an important socioeconomic problem, and the results of the surgical management of lumbar degenerative disorders have a wide variation throughout the literature, possibly because of the several factors affecting pain level and perception in this group of patients. This study aims to evaluate the influence of nonorganic signs on the outcomes of lumbar fusion for degenerative pathologies. The secondary aim is to evaluate the capacity of physicians to identify patients at risk for poor results secondary to nonorganic signs.
Material and Method: Prospective clinical study, with independent data collection and analysis pre- and postoperatively (6 months). Patient selection included those with indication for lumbar surgery secondary to lumbar degenerative pathology up to three levels, failure of conservative treatment for at least 6 months and capability to understand the questionnaires and the informed consent. Staff physicians evaluated patients subjectively regarding the presence of depressive and/or nonorganic signs; if the physician suspected that the patient had signs of depression or nonorganic signs, the patient would be excluded from the study. Overall, 60 patients were followed with DRAM, Zung, Oswestry disability questionnaire, presence of nonorganic signs, and VAS pre- and postoperatively. Data regarding spine pathology and patient's medical history were also collected.
Results
There were no significant differences regarding pain levels and surgical results between patients with (n = 26) and without (n = 30) nonorganic signs. The same happened with high (50% of the patients) and low scores using the DRAM and Zung evaluation of depressive symptoms.
Conclusion
Although results were similar in the subset of patients, this study showed that subjective analysis was not able to correctly identify patients with risk factors for depression, and that the application of specific questionnaires such as the ones in this study help to improve patient selection for lumbar spine procedures.