Surgical Fear and Preference in Spine Disorders: A Prospective Study of Tomophobia and Tomophilia

Background Treatment decisions in spine disorders are influenced by both clinico-radiological factors and psychological determinants. Tomophobia (fear of surgery) and tomophilia (positive inclination toward surgery) are emerging constructs that may significantly influence surgical decision-making, but remain insufficiently characterized. This study highlights the role of structured clinico-radiological correlation (CRC) combined with psychological assessment to improve accuracy of decision-making in spine care. Methods and materials This prospective observational study included 200 adult patients with cervical, thoracic, or lumbar spine disorders for whom both operative and non-operative management were clinically appropriate. The study was prospectively registered in the Clinical Trials Registry-India (CTRI No.: SSHRI/CS/NS/Tphobia-philia/BRD/88/12.25). Baseline demographic and clinical data were recorded. Pain and disability were assessed using a visual analog scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). Psychological evaluation included Generalized Anxiety Disorder 7-item Scale (GAD-7), Pain Catastrophizing Scale (PCS), and a structured questionnaire assessing tomophobia and tomophilic inclination. All patients underwent CRC, and diagnostically uncertain or overlapping cases were further reviewed using a structured in-house multi-tier reassessment protocol. Associations between psychological traits and treatment preference were analyzed. Results Tomophobia was present in 62/200 patients (31.0%), while tomophilic inclination was observed in 138/200 patients (69.0%). Overall, 138/200 patients (69.0%) opted for surgical management, 51/200 patients (25.5%) chose conservative treatment, and 11/200 patients (5.5%) remained undecided following counselling. A significant association was observed between psychological disposition and treatment preference (p<0.001). Tomophobic patients predominantly selected conservative or undecided options, whereas tomophilic patients strongly preferred surgery. Tomophobia was associated with higher GAD-7 and PCS scores, while VAS and disability indices (ODI/NDI) were comparable across groups. CRC-guided in-house reassessment improved diagnostic clarity in selected overlap cases and refined treatment decisions. Conclusions Tomophobia and tomophilia represent important psychological determinants of treatment preference in spine disorders, operating independently of objective clinical severity. Patients with tomophobia demonstrate increased anxiety and catastrophizing tendencies, contributing to conservative or indecisive treatment choices, whereas tomophilic inclination is strongly associated with preference for operative management. The findings underscore the importance of integrating structured CRC with systematic psychological evaluation and a standardized in-house multidisciplinary review process to minimize diagnostic ambiguity, optimize patient selection, and ensure balanced shared decision-making in spine care.