Psychologic readiness for adult spinal deformity surgery: practical screening and optimization pathways

Area of Science:

• Orthopedic Surgery
• Psychology
• Spine Deformity Correction

Background:

• Adult spinal deformity (ASD) surgery aims to improve patient outcomes through radiographic correction.
• Psychologic readiness is increasingly recognized as a key factor influencing recovery and satisfaction after ASD surgery.

Purpose of the Study:

• To review existing data on psychologic readiness in the context of ASD surgery.
• To present a practical framework for screening and optimizing psychologic readiness in patients undergoing ASD surgery.

Main Methods:

• A comprehensive literature review was conducted using PubMed and Embase.
• Searches focused on ASD surgical populations, examining perioperative outcomes related to mental health, pain coping, sleep, opioid use, cognitive function, and expectations.
• Broader spine surgery literature was included where ASD-specific data were limited.

Main Results:

• Preoperative factors such as mental health symptoms, pain coping, sleep quality, opioid exposure, cognitive status, and expectation alignment significantly impact disability, satisfaction, and recovery after ASD surgery.
• These factors are best utilized for risk stratification and targeted interventions rather than as absolute surgical contraindications.
• A practical workflow involving brief screening, selective add-on tools, tiered classification, and standardized responses was proposed.

Conclusions:

• Psychologic readiness assessment is feasible in adult spinal deformity practice through a brief core screen and tiered response pathway.
• This approach enables surgeons to identify and address readiness barriers, align patient expectations, and coordinate optimization strategies effectively.
• The proposed framework aims to enhance patient outcomes and satisfaction without causing undue delays in indicated surgical treatments.