Prehab as an Alternative to Elective Spine Surgery

Hypothesis—A structured screening protocol including assessment of psychological well-being with subsequent self-directed physician supervised noninterventional treatment protocol can successfully avoid elective lumbar spine surgery while optimizing patient well-being. Background—Certain patients with chronic LBP without focal neurological deficits or significant instability or deformity may benefit from optimization of their psychological well-being before contemplating elective low-back surgery. In certain cases these interventions may actually ameliorate the patient symptoms to a degree that the originally planned surgery is no longer pursued while the patients experience a substantial improvement of their quality of life.Material and Methods From January 2012 onwards a routine protocol at the Swedish Neurosciences Institute required new patients presenting to our spine clinics to complete routine psychological testing for anxiety, depression, and irritability. All patients with abnormal scores in any of the categories were placed into a structured “prehab” program with a self-directed mental and physical health program. Only patients who had presented with degenerative lumbar disorders, such as central or foraminal spinal stenosis and mild degenerative spondylolisthesis that corresponded with their symptoms were considered candidates for surgery.Results During a required minimum 1-year follow-up of 25 patients selected for a formal “Prehab program” due to their abnormal psychological profiles we identified no cases of neurological decline, no conversions to surgery, and confirmed statistically significant improvement in patient-related outcomes scores (ODI, VAS, opiate index, and psychological wellness scores). Interestingly none of these patients required interventional spine management during our observation period while also increasing their functional activity profiles based on reported activity tolerances.Conclusion We identified two potential conclusions based on our early results: (1) Inclusion of psychological wellness testing including screening for anxiety, depression, and irritability may be a valuable adjuvant to routine other screening tests for elective lumbar spine surgery. (2) Emphasis on correction of abnormal psychological profiles in a formalized “Prehab program” may positively influence patients' subjective well-being to the point where surgical care may be delayed or not required anymore. Further investigation of a “mind body syndrome” in its spinal symptom manifestations may be warranted to optimize patient selection and treatment outcomes.