Depression Identified on the Mental Component Score of the Short Form-12 Affects Health Related Quality of Life After Lumbar Decompression Surgery

Abstract

Study Design: This was a retrospective comparative study. Objective: The goal of this study was to further elucidate the relationship between preoperative depression and patient-reported outcome measurements (PROMs) following lumbar decompression surgery. Summary of Background Data: The impact of preoperative depression on PROMs after lumbar decompression surgery is not well established. Methods: Patients undergoing lumbar decompression between 1 and 3 levels were retrospectively identified. Patients were split into 2 groups using a preoperative Mental Component Score (MCS)-12 threshold score of 45.6 or 35.0 to identify those with and without depressive symptoms. In addition, patients were also split based on a pre-existing diagnosis of depression in the medical chart. Absolute PROM scores, the recovery ratio and the percent of patients achieving minimum clinically important difference between groups were compared, and a multiple linear regression analysis was performed. Results: A total of 184 patients were included, with 125 (67.9%) in the MCS-12 >45.6 group and 59 (32.1%) in the MCS-12 ≤45.6 group. The MCS-12 ≤45.6 and MCS<35.0 group had worse baseline Oswestry Disability Index (ODI) (P<0.001 for both) and Visual Analogue Scale Leg (P=0.018 and 0.024, respectively) scores. The MCS ≤45.6 group had greater disability postoperatively in terms of SF-12 Physical Component Score (PCS-12) (39.1 vs. 43.1, P=0.015) and ODI (26.6 vs. 17.8, P=0.006). Using regression analysis, having a baseline MCS-12 scores ≤45.6 before surgical intervention was a significant predictor of worse improvement in terms of PCS-12 [β=−4.548 (−7.567 to −1.530), P=0.003] and ODI [β=8.234 (1.433, 15.035), P=0.010] scores than the MCS-12 >45.6 group. Conclusion: Although all patients showed improved in all PROMs after surgery, those with MCS-12 ≤45.6 showed less improvement in PCS-12 and ODI scores.

Depression Increases Posterior Cervical Decompression and Fusion Revision Rates and Diminishes Neck Disability Index Improvement

“…Previous research in patients undergoing ACDF has demonstrated an association between preoperative depressive symptoms and worse clinical outcomes postoperatively, although those with depressive symptoms still achieved significant improvement following surgery 13–16. Similar results have also been reported postoperatively in patients undergoing lumbar decompression with or without fusion 17–21…”

“…Our findings suggest that patients with depression will have meaningful one-year postoperative patient-reported improvements following surgery, and they should not be excluded from surgical intervention based on their mental health history, aligning with previous studies in ACDF and lumbar surgery. 15,17,21 An important finding from our study is the high rate of revision surgery in patients with a past medical history of depression and/or anxiety. Although our cohort of nondepression/anxiety patients had revision rates below 1%, which was comparable to the 1.1% pooled revision rate found in a meta-analysis of 31 PCDF studies, our overall revision rate was 4.1%.…”

“…18 Copyright r 2022 Wolters Kluwer Health, Inc. All rights reserved. Similar to Divi et al 17 using an ACDF cohort, retrospective cohorts of 184 patients and 391 patients examined the influence of depressive symptoms using MCS-12 cut-offs for patients undergoing lumbar fusion and decompression procedures, respectively. 17,21 They found that preoperative depressive symptoms, as measured by MCS-12, were associated with decreased improvement in clinical outcomes following surgery, although the patients in the depression group still experienced significant improvements following surgery.…”

“…The importance of mental health on clinical outcomes following surgery has been established across multiple specialties 9–11. Although improved postoperative outcomes have been reported in patients without anxiety and/or depression in anterior cervical and lumbar spine patient populations, this is typically due to worse preoperative patient-reported outcomes in the depression and/or anxiety groups 14,15,17,21. The impact of depression and anxiety on surgical spine patients is of particular importance, as an increased prevalence of depression and anxiety exists in patients experiencing neck or low back pain 26–29.…”

“…[13][14][15][16] Similar results have also been reported postoperatively in patients undergoing lumbar decompression with or without fusion. [17][18][19][20][21] Despite a clear association between mental health and outcomes following anterior cervical surgery, there is a paucity of literature investigating the role of depression and anxiety on subjectively reported outcomes following PCDF. 14,15,22 Accordingly, the purpose of this study is to investigate whether a past medical history of depression and/or anxiety significantly affects patient-reported outcomes following PCDF.…”