Psychopathological Influences on Surgical and Clinical Outcomes in Lumbar Disk Herniation: Prediction Models and Literature Analysis

Background/Objectives: Lumbar disk herniation (LDH) significantly affects quality of life due to lower back and radiating leg pain. Surgical intervention, such as discectomy, is effective for symptom relief when conservative measures fail; however, psychological factors like anxiety, depression, and maladaptive coping strategies may negatively impact surgical outcomes. This study aims to assess the role of preoperative psychological evaluations in predicting postoperative recovery and to identify key psychological and functional predictors of surgical success. Methods: A prospective study was conducted on 888 patients undergoing microdiscectomy for LDH at Mater Olbia Hospital between December 2020 and December 2023. Preoperative evaluations included the Visual Analog Scale, Symptom Checklist 90-R, Oswestry Disability Index, and Short Form 36. Logistic regression models and ROC curve analysis were used to identify significant predictors of outcomes and evaluate model accuracy. Results: Preoperative pain levels and emotional well-being emerged as the strongest determinants of postoperative improvement in the Oswestry Disability Index. The predictive model demonstrated high specificity (90.2%) in identifying patients likely to benefit from surgery. Clinically significant improvements were achieved by 69% of patients, highlighting the importance of psychological and functional assessments. Conclusions: Preoperative psychological assessment is critical in predicting outcomes of lumbar disk herniation surgery. Addressing psychological factors preoperatively enhances recovery, supports personalized treatment planning, and improves patient education. These findings advocate for an integrated care model that considers both physical and psychological health, optimizing surgical outcomes and patient satisfaction.