Abstract
Introduction
Recently, posttraumatic stress disorder symptoms (PTSD) were found in 20% of cases following elective spine surgery. PTSD was therefore attributed to surgery. Furthermore, PTSD symptoms were associated with reduced clinical benefit. However, PTSD is seen in up to 10% of the normal population. Aim of this study is to evaluate the incidence of PTSD before and after elective spine surgery and the influence of PTSD on clinical outcome.
Methods
A prospective study of patients undergoing elective spine surgery was performed. The patients were evaluated for PTSD using the PTSS score before surgery and 3 months postoperatively. In addition SF36 physical composite score (PCS), Oswestry Disability Index (ODI) and pain visual analog scale (VAS) were completed preoperatively and at 3 months postoperatively. Incidence and influence of PTSD symptoms on clinical outcome were examined.
Results
144 patients met all inclusion criteria. 78 patients were male (54.2%); mean age was 59.49 years. PTSD symptoms were reported in 59 patients (41%) before surgery. However, only 32 patients (22.2%) still had abnormal PTSS scores at 3 months follow up. Only 6 patients (4,17%) developed PTSD symptoms following surgery. PTSD was associated with worse clinical outcome before surgery in the ODI score (ODI: 18.45 versus 43.16, p = 0.000). There were also statistically significant differences in mean SF36 PCS score (p = 0.000) and pain VAS (p = 0.000) between both groups. At three months follow up patients with PTSD showed worse clinical outcome in the ODI score and VAS pain (ODI: 10.89 vs 28.43, p = 0.000; VAS: 11 vs 4.26, p = 0.000) and also in the SF36 PCS score (p = 0.000).
Conclusions
PTSD symptoms are associated with worse outcome following elective spine surgery. However, the vast majority of patients with PTSD symptoms exhibit symptoms before surgery and only a small minority develop PTSD symptoms after surgery.