Oral Posters: Thoraco-lumbar Degenerative

Presented by: X. Hu - View Audio/Video Presentation (Members Only)


X. Hu(1), A. Block(2), S. Bederman(1), I. Lieberman(1)

(1) Texas Back Institute, Texas Health Presbyterian Hospital Plano, Scoliosis and Spine Tumor Center, Plano, TX, United States
(2) Texas Back Institute, Plano, TX, United States


Introduction: Although spine surgeries have been shown to improve pain, physical function and disability in the majority of patients, some patients remain dissatisfied with their outcomes. Patient activation, an individual's propensity to engage in adaptive health and rehabilitation behaviors, is a potentially important factor contributing to the variations in postsurgical outcome. The purpose of this study is to prospectively evaluate patient activation in a series of individuals undergoing spine surgery and to examine the possible factors that affect activation in these patients.

Methods: Adult patients who were scheduled to have spine surgery with two surgeons were consented and prospectively enrolled in the study. Pre-operatively, the Patient Activation Measure (PAM) was used to assess their activation level (higher score = better activation, scale 0-100). The State-Trait Anxiety Inventory (STAI) was used to assess the patients' current (state) and past (trait) anxiety states (higher score = more anxiety, scale 0-80). The CES-D depression scale was used to assess the patients' depression state (higher score = more depression, scale 0-60). The patients' demographics and pre-operative diagnosis were also recorded.

Results: A total of 79 patients were enrolled in the study. The patients' mean age was 58 years (range 19-83) and 51 patients (64.6%) were female. The patients' mean PAM score was 70.5 points (range 20.9-100). The patients' activation scores were significantly lower in those patients who have depression (64.0 vs 72.8, p=0.05) and past anxiety (58.1 vs 72.5, p=0.02). Those patients who have previous spine surgery and current anxiety also had lower activation scores but the differences were not statistically significant (p=0.09 and 0.07 respectively). Meanwhile, the patients' gender, age, BMI and the presence of spinal deformity have no correlation with the patients' activation scores.

Conclusion: Our data shows that the presence of pre-operative depression and anxiety has a negative impact on patient activation in individuals undergoing spine surgery. Further studies are underway to examine if low patient activation scores are associated with inferior surgical outcomes and the possible role of pre-surgical psychological intervention in those patients low PAM scores.