Impact of structured psychological support on anxiety and recovery in anterior cervical discectomy and fusion: a randomized controlled trial

STUDY DESIGN: Prospective randomized clinical trial. PURPOSE: In this prospective, open-label, parallel-group randomized clinical trial, we assessed whether structured psychological support reduces perioperative anxiety and enhances recovery in anterior cervical discectomy and fusion patients. METHODS: Ninety patients (July 2020 to July 2024) were randomized 1:1 to receive standard preoperative communication plus structured psychological support (intervention, n = 45) or communication alone (control, n = 45). The primary outcome was the State-Trait Anxiety Inventory score; secondary outcomes included Visual Analog Scales, the Neck Disability Index, Pittsburgh Sleep Quality Index, patient satisfaction, and swallowing function (Bazaz score). RESULTS: Eighty-three patients completed follow-up (forty-two intervention and forty-one control). Immediately postoperative and on day 1, the intervention group reported significantly lower State-Trait Anxiety Inventory scores (Δ = 4.28 to 4.61, p < 0.001, Cohen's d = 0.77 to 0.80), with no between-group differences by day 3 or after one month. Linear mixed modelling confirmed a sustained group effect (p < 0.001) and time-related anxiety remission (p < 0.001). On day 1, intervention patients reported lower Visual Analog Scales (Δ = 1.12, p = 0.001), and by one month, the Neck Disability Index improvement reached clinical relevance (Δ = 2.59, p = 0.019). The Pittsburgh Sleep Quality Index on day 3 and patient satisfaction immediately and on day 3 were also higher (all p < 0.05). No differences in swallowing function or safety indicators were observed. CONCLUSION: Structured psychological support safely and effectively reduces early postoperative anxiety and improves short-term pain, function, and sleep, with short-term functional benefits, supporting its inclusion in perioperative multimodal management. PATIENT OR PUBLIC CONTRIBUTION: Patients or members of the public were not involved in the design, conduct, analysis, or reporting of this study.