The Impact of Preoperative Psychological Interventions on Postoperative Outcomes in Spine Surgery: A Systematic Review.
STUDY DESIGN: Systematic review conducted under PRISMA guidelines. OBJECTIVE: To evaluate the impact of preoperative psychological interventions on spine surgery postoperative outcomes. SUMMARY OF BACKGROUND DATA: Approximately one-third of individuals with chronic back pain report symptoms of preoperative anxiety and depression, which may worsen with surgery. Despite the increased risk for mental health comorbidity, preoperative psychological interventions are not well utilized in spine surgery preoperative care. METHODS: Literature search was conducted using the PubMed, EMBASE, Web of Science, and APA PsycINFO databases until August 22, 2025. The inclusion criteria consisted of adult spine surgery patients, preoperative psychological interventions, and the presence of postoperative outcomes. Primary data extraction factors included study type, patient population and demographics, diagnosis, and the specific psychological intervention used. RESULTS: Thirteen studies representing 9316 patients were included. Pharmacotherapy showed a significant positive association with pain reduction in 4/6 analyses. No analyses studying pharmacotherapy and disability or mental well-being showed a significant positive association with disability reduction or with mental well-being improvement. All studies of cognitive behavioral therapy (CBT) measuring disability (2/2) showed a positive significant association with disability reduction. The study of CBT measuring mental well-being (1/1) showed a positive significant association with mental well-being improvement. CBT did not have a positively significant association in studies measuring reduction in pain. Stress-relief methods had positive significant associations with better mental well-being in half of studies, and pain reduction in 3 out of 4 studies. No studies measured stress-relief methods' effect on disability. CONCLUSIONS: This systematic review highlights that a range of preoperative psychological interventions have a significant positive association with improved postoperative outcomes. It also describes the current state of literature in an understudied field. Further research is needed to identify optimal timing of interventions and prospective studies are needed to evaluate clinical applicability for implementation. LEVEL OF EVIDENCE: Level I.
