An Oregon Health and Science University study revealed that 20 percent—or 1 in 5—of its 73 participants exhibited PTSD symptoms within the first year of having spinal fusion surgery. For patients considering spinal fusion, these findings should encourage pre-operative conversation with their doctor or surgeon about the psychological impact of the procedure. This dialogue also helps patients who may be at-risk for PTSD or like symptoms to receive a proper treatment plan for potential depression, anxiety and other mental health risks prior having the procedure.
What is PTSD?
PTSD is a mental health condition marked by flashbacks, night terrors, and intense fear triggered by reminders of traumatic events. This condition, which is associated with men and women in the Armed Forces and sexual assault victims, can also affect patients of major operations after surgery. For fusion patients, if a traumatic event—an auto accident, sports injury, or other trauma—causes the need for surgery, post-surgical PTSD is possible.
- 70% of adults in the U.S. have experienced some type of traumatic event at least once in their lives. This equates to approximately 223.4 million people
- Up to 20% of these people go on to develop PTSD. As of today that equates to approximately 44.7 million people who were or are struggling with PTSD.
- An estimated 8% of Americans—24.4 million people—have PTSD at any given time. That is equal to the total population of Texas.
Who Is at Risk?
People who suffer severe psychological effects following spinal fusion surgery are likely to be predisposed. Patients entering surgery who have been battling depression or anxiety are at higher risk for those conditions worsening or becoming PTSD.
For some patients, the fear of a long recovery, unexpected set back, or questions about changes in lifestyle—especially if it’s life altering or career ending as with athletes—after the procedure can produce a stress response that can lead to depression, anxiety, or PTSD. This potential makes it even more important for doctors and patients to have conversations about expectations.
“Surgery can be a traumatic experience for some patients, particularly those who people with active lifestyles. My job is to address those concerns prior to surgery, answering any and all questions about how the procedure works, what recovery will look like, and when they can expect to be back doing things that matter to them. I want my patients to have a realistic timeline so that we can proactively prevent things like depression or stress from affecting their recovery,” says Dr. Scott Blumenthal, a spine surgeon with the Texas Back Institute.
Another concern surrounding PTSD and spinal fusion is the potential that symptoms could interfere with its effectiveness. One way is through chronic muscle tension, brought on by anxiety, tightening the muscles through a person’s natural fight-or-flight response. Another way is through anxiety overstimulating the amygdala, the area of the brain involved with emotions. This mental reaction can create the sensation of physical pain. As anxiety sets in, the affected person becomes sensitive how their body feels. This hypersensitivity causes them to notice every ache, pain, and discomfort. Often out of their control, this is part of the disorder.
With fusion contributing to PTSD in patients, is there a suitable alternative that reduces cases of anxiety set on by drastic lifestyle changes during the recovery period?
Artificial Disc Replacement
Evidence from studies suggest that patients with a spinal fusion may be six times more likely to be treated for adjacent segment disease than those who undergo artificial disc replacement. In presenting evidence from a patient trial at the 2017 Advancement of Spine Surgery Annual Meeting, Dr. Richard Guyer shared that after five years, the artificial disc “had a protective effect on the progression of DDD at adjacent levels in 91.2% of patients.” For patients concerned about recovery downtime or the need for additional surgeries, which can cause anxiety, the data on artificial disc replacement points to a solution that can prevent mental distress.
“As surgeons, we recognize the psychological impact that surgery presents the patient. Our aim is to recommend and perform a surgery, such as disc replacement, that hopefully eliminates their pain, it’s compatible with their lifestyle, and gets them back on their feet so that the stress of being away from work or the things they enjoy is minimized,” says Blumenthal, whose practice focuses on the research and application of artificial disc replacement.
In an interview, Dr. Jack Zigler vouched for the outcome of patients with artificial discs. He said, “We know that patients with an artificial disc go back to work faster, have better range of motion, and use fewer narcotics and muscle relaxers than patients who had fusions.”
This means patients with artificial discs have a lower likelihood for an additional surgery, which is a trigger for fusion-caused PTSD.
“We think that over a longer period of observation, the results will translate into a significant decrease in re-operations or operations at adjacent vertebral levels. However, we think in 10 to 15 years from surgery, the change we see radiographically (e.g., on x-ray evaluation) will translate into a reduced need for adjacent level surgery, which will be a huge advantage for artificial discs.”
Before receiving a spinal fusion, patients should know potential mental health risks. If you have had a spinal fusion and are concerned that you may be exhibiting symptoms consistent with PTSD—depression, anxiety, hopelessness, detachment, intense thoughts and feelings about a traumatic event, trouble getting your life back under control—talk to your doctor. Seeking help is the quickest way to prevent PTSD symptoms from worsening.