THE PREDICTION OF GOOD OUTCOMES IN SPINAL SURGERY WITH SOMATISED PATIENTS

Abstract

Aims: To determine outcomes in somatised patients and identify factors of clinical utility that help predict favourable and unfavourable results.

Introduction: Somatisation is a tendency to experience and express somatic distress and symptoms unaccounted for by pathological findings and to attribute them to physical illness, often with excess seeking of medical help for them. Somatised patients undergoing spinal surgery have less favourable outcomes than the normal surgical population. However a range of outcomes occur.

Methods: Prospective data from a single centre was obtained. Pre-operative modified somatic perception (MSP) and modified Zung depression (MZD) scores were available on 993 patients. The 46 patients with high somatic scores were identified as a discrete sub-group. Some patients did extremely well some patients had poor outcomes. Quantification of the number of consultants seen, outpatient clinic (OPD) reviews and duration of symptoms were compared to indicators of poor outcome (unchanged or increased visual analogue score (VAS), increased or < 10 point decrease in Oswestry disability index (ODI)) at 6 and 12 months of follow up.

Results: In the 46 patients the mean pre surgical scores were ODI 64.9 (SD 12.75) MSP 16 (SD 7.74); MZD 38 (SD 10.4); Prior to surgery they had a mean of 9.6 OPD attendances, the average number of consultants seen was 3.28 (SD 2.83). Overall the post-operative mean ODI was 36.81 (SD 24.58) a clinically satisfactory improvement. At 6 months patients who have a good outcome (ODI) had had an increased number of orthopaedic consultations (60% vs. 39.7%) but this was not statistically significant; p=0.16. At 12 months patients with a good outcome (ODI) had waited a lower number of months before surgery (5.5 vs. 11; p=0.026). Across all other parameters, including gender, age, surgical procedure undertaken, no other significant correlation exists between OPD, consultants seen and the changes in VAS, ODI at 6 and 12 months of follow up.

Conclusions: Dramatic differences exist between somatised patients who have good and poor outcome following spinal surgery. The number of months from decision to operate to surgery appears to predict good outcome at 12 months. No other identifiable pre-op factors were found.