Cognitive behavioral therapy as a psychological optimization strategy in spine surgery: a scoping review

Psychosocial factors such as pain catastrophizing, fear-avoidance behaviors, and depression are associated with poor outcomes after spine surgery. Cognitive behavioral therapy (CBT) is a structured psychological intervention shown to improve coping, reduce disability, and mitigate pain in musculoskeletal conditions. However, its role and implementation in surgical spine populations remain variable.

This scoping review aims to evaluate how CBT has been applied in spine surgery settings and synthesize findings related to patient-reported outcomes, opioid use, and rehabilitation trajectories.

A comprehensive search was conducted across Ovid Medline, PubMed, and Scopus. Inclusion criteria were (1) adult spine surgery population, (2) CBT-based intervention (pre- or postoperatively), and (3) reporting on functional, psychological, or opioid-related outcomes. Seven eligible studies were included.

CBT was delivered preoperatively in 3 studies and postoperatively in 4 studies. Commonly measured outcomes included ODI, PCS, FABQ, and VAS. Across studies, CBT was associated with reduced disability, improved pain coping behaviors, and accelerated early recovery. Telehealth delivery was feasible and effective in some contexts. However, session frequency, provider type, and mode of delivery varied substantially. Long-term benefit beyond 6-12 months was inconsistent.

CBT appears to be a valuable adjunct to spine surgery recovery, particularly for high-risk patients. Yet, heterogeneity in implementation highlights the need for standardized protocols and long-term outcome evaluation.