My husband is thinking about having a spinal fusion. The surgeon wants him to take some mental tests first. I don’t know if they think he’s a hypochondriac or not. But I can tell you he hardly ever complains about anything and this back pain is real. Should I say something to the doctor?

Results from spinal fusion surgeries haven’t always been consistently positive. Surgeons and researchers are trying to narrow down the reasons for failures and less than satisfactory results. One approach has been to select patients carefully for success. This way of improving clinical outcomes is called patient selection criteria.

By studying groups of patients who have done well and comparing them to patients who have not had as good of a result, they are identifying risk factors that help predict who will be a good candidate for spinal fusion. Studies done so far have shown that osteoporosis (brittle bones), spinal stenosis (narrow spinal canal), and severe disc space narrowing are linked with worse outcomes.

Time off from work before surgery and psychologic status also have an effect on results of lumbar spine surgery. It has been shown that patients who are off work for more than 13 weeks before surgery recover more slowly and not as fully as those who work longer before having surgery.

There may be a behavioral or psychologic reason that is common among those individuals who are off work longer. Those same psychologic or behavioral factors might be the reason results aren’t better than they are after spine surgery. In general, psychologic screening has been effective in predicting worse results after lumbar spine surgery.

Your husband’s surgeon may screen patients routinely. It’s the same as doing blood testing to make sure everything is a go for surgery. But there’s nothing wrong with bringing up your concerns, questions, and comments. Understanding the preoperative process is always an important part of patient care.