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I am scheduled for spinal surgery (fusion) in two weeks. As part of the work-up, I've had to fill out tons of paperwork including questions about my lifestyle (do I smoke? am I overweight? how do I spend my leisure time?). There was even one survey just about depression and anxiety. Is all this really necessary? It makes me feel like the doctor doesn't believe me when I tell her I'm having such intense, constant pain all the time.

Patients who have any type of spinal surgery can end up with persistent back and leg pain. This outcome is distressing to both the patient and the surgeon when just the opposite was expected (pain relief and improved function). Research to find out why these patients don't get better is underway. If the surgeon can identify ahead of time factors that might predict failure, then the plan of care can be adjusted accordingly. By finding preoperative predictive factors, researchers hope to help surgeons identify and preselect patients for surgery who will have a good result. Predictive factors can be almost anything: age, health, sex (male or female), menopausal status for women, tobacco and/or alcohol use, body mass index (BMI), and so on. In fact, depression is one of those factors that has come up as a risk for recovery. Studies have revealed that psychologic problems such as anxiety or depression can have an affect on patient results after spinal surgery. But which came first: the depression followed by back pain or the back problem and then the depression? Is depression a predictor of results after a second (revision) surgery? Researchers are evaluating each of these questions. Knowing the role of depression guides further research efforts. Recognizing that nonspinal health problems (including mental health issues) can affect the results of surgery is a big eye-opener. The next step may be to see if depression has the same influence on other types of treatment. Defining the role of other potential factors (e.g., diabetes, smoking, obesity, duration of symptoms before surgery) will also be important. You are in good hands if your surgeon knows about the link between specific risk factors and results of surgery. If it turns out that you might not be such a good candidate for surgery, then the surgeon can suggest a more appropriate (and potentially more successful) approach.

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