Most conversations about the risks of spinal fusion surgery focus on the possible physical risks; failed back surgery syndrome and adjacent segmental degeneration are common concerns. A new study highlights a long-neglected risk factor associated with the surgery: post-traumatic stress disorder (PTSD).
PTSD is a condition that develops when a person witnesses or undergoes a terrifying event that threatens or realizes physical harm to himself or another. The condition often manifests among victims of abuse, rescue workers and service members. The intense fear and agitation involved in PTSD can prevent the affected person from living a normal life. Symptoms include reliving the horrifying event in flashbacks and nightmares, avoiding places, people and things that remind you of the event, intensified emotions, insomnia, jumpiness, hyper-alertness and problems with interpersonal relationships, such as difficulty expressing emotion or affection.
Besides being unpleasant psychologically, it is possible that PTSD could interfere with the effectiveness of spinal fusion. This can happen in a couple ways. 1) The agitation involved with PTSD can cause physical pain by creating chronic muscle tension. Living in constant anxiety means that the fight or flight response is always active. When the brain senses danger, it sends signals that contract the muscles. This is meant to prepare you for action, but in the case of PTSD, it just causes chronic muscle tension. 2) The amygdala is a part of the brain that processes both mental and emotional pain signals. An increase in emotional pain can lead to over-activity of the amygdala, which can translate physically into increased sensation of pain. This debunks the “all in your head” diminution of pain, since it speaks to the very real physical sensation of pain that is linked to emotional stimuli.
It is highly important, therefore, to consider the psychological risks of surgery. Patients with psychological challenges may choose not to have surgery based on the risk of PTSD. If surgery is deemed necessary, patients should be treated for depression, anxiety and other risk factors before the procedure. PTSD may be treated by different forms of therapy, such as cognitive behavioral therapy, group therapy, exposure therapy and psychodynamic therapy. Medications such as anti-depressants and tranquilizers are often used as well. A combination of the drug and therapeutic approaches may be necessary in some cases, but therapy should be a component of all PTSD treatment plans.
Spinal fusion risks come in both physical and psychological form. Be aware of all your risks before agreeing to a procedure and research alternative forms of pain treatment before undergoing invasive procedures.