Psychological Risk Factors for Poor Outcome of Spine Surgery and Spinal Cord Stimulator Implant: A Review of the Literature and Their Assessment With the MMPI-2-RF

Abstract

Back pain is experienced by up to of 85% of the United States population. Most often it resolves with minimal to no medical treatment. For those whose pain endures, worsens, or becomes protracted, conservative care is typically first attempted. Individuals who continue to experience significant back pain are often considered for surgical procedures, the results of which are not uniformly positive. The consequences of failed surgical intervention can be quite devastating, and psychosocial factors have been found to predict poor outcome. The literature on psychosocial risk factors for failed back surgery is reviewed first, identifying psychological dysfunction in the domains of emotions, cognitions, behavior, and interpersonal processes as increasing the risk for failed back surgery. Empirical findings with the MMPI-2 Restructured Form (MMPI-2-RF) are presented next, including descriptive analyses with a sample of 1341 individuals assessed as part of a pre-surgical psychological screening. Correlations between MMPI-2-RF scale scores and measures of the primary risk factors identified in this review are reported for a smaller sample of 197 pre-surgical candidates. Interpretive implications of the MMPI-2-RF findings are discussed along with suggestions for further research in this area.

Keywords:

• The Minnesota Multiphasic Personality Inventory-2 Restructured Form
• MMPI-2-RF
• Spinal cord stimulator
• Spine surgery

Notes

¹ The findings reported here are from the first phase of a longitudinal investigation of using the MMPI-2-RF to predict back surgery outcome. Here we report descriptive findings with the test for samples of spine surgery and spinal cord stimulator implant candidates and base-line correlations between MMPI-2-RF scales and commonly used measures of established risk factors for poor outcome.

² Some participants met more than one exclusionary criterion.

³ A copy of the revised algorithm is available upon request from Andrew Block ([email protected]).