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

Abstract

Study Design. A retrospective cohort study. Objective. To determine if depression and/or anxiety significantly affect patient-reported outcome measures (PROMs) after posterior cervical decompression and fusion (PCDF). Summary of Background Data. Mental health diagnoses are receiving increased recognition for their influence of outcomes after spine surgery. The magnitude that mental health disorders contribute to patient-reported outcomes following PCDF requires increased awareness and understanding. Materials and Methods. A review of electronic medical records identified patients who underwent a PCDF at a single institution during the years 2013–2020. Patients were placed into either depression/anxiety or nondepression/anxiety group based on their medical history. A delta score (∆) was calculated for all PROMs by subtracting postoperative from preoperative scores. χ2 tests and t tests were utilized to analyze categorical and continuous data, respectively. Regression analysis determined independent predictors of change in PROMs. Alpha was set at 0.05. Results. A total of 195 patients met inclusion criteria, with 60 (30.8%) having a prior diagnosis of depression/anxiety. The depression/anxiety group was younger (58.8 vs. 63.0, P=0.012), predominantly female (53.3% vs. 31.9%, P=0.007), and more frequently required revision surgery (11.7% vs. 0.74%, P=0.001). In addition, they had worse baseline mental component (MCS-12) (42.2 vs. 48.6, P<0.001), postoperative MCS-12 (46.5 vs. 52.9, P=0.002), postoperative neck disability index (NDI) (40.7 vs. 28.5, P=0.001), ∆NDI (−1.80 vs. −8.93, P=0.010), NDI minimum clinically important difference improvement (15.0% vs. 29.6%, P=0.046), and postoperative Visual Analog Scale (VAS) Neck scores (3.63 vs. 2.48, P=0.018). Only the nondepression/anxiety group improved in MCS-12 (P=0.002) and NDI (P<0.001) postoperatively. Depression and/or anxiety was an independent predictor of decreased magnitude of NDI improvement on regression analysis (β=7.14, P=0.038). Conclusion. Patients with history of depression or anxiety demonstrate less improvement in patient-reported outcomes and a higher revision rate after posterior cervical fusion, highlighting the importance of mental health on clinical outcomes after spine surgery.

Prognostic Value in Preoperative Veterans RAND-12 Mental Component Score on Clinical Outcomes for Patients Undergoing Minimally Invasive Lateral Lumbar Interbody Fusion

“…In our study, the worse mental health cohort reported increased perceived pain on POD 0. Prior literature supports this finding with worse baseline mental health being identified as a serious comorbidity linked to increased postoperative pain [ 3 , 23 - 28 ]. Another study that followed patients for 2 years post lumbar surgery found that worse scores on the Beck Depression Inventory were correlated with inferior scores in VAS pain across the entire follow-up period [ 25 ].…”

“…These results are supported by studies that demonstrated worse mental health being associated with inferior postoperative outcomes after both cervical and lumbar spine surgery, as demonstrated by poorer VAS-BP, ODI, and Neck Disability Index (NDI) scores [ 30 , 31 ]. One study found that patients with depression or anxiety reported inferior scores in PROMs such as NDI, VAS-neck pain, and SF-12 MCS after elective posterior cervical discectomy and fusion [ 23 ]. Studies also found that patients with worse baseline mental health continued to report inferior mental health scores and experienced more psychiatric complications postoperatively [ 19 ].…”

Influence of preoperative depression on clinical outcomes after cervical laminoplasty: A retrospective study

“…Previous studies have shown there are some factors which can affect the curative effect of posterior cervical surgery, such as age ( 31 ), gender ( 32 ), smoking ( 33 ), symptom duration ( 34 ) and so on ( 35 ). Other studies have confirmed that mental factors affect the results of surgery in heart surgery, brain surgery, transplantation surgery and thoracic surgery ( 14 , 36 – 40 ).…”

Publication Trends in Research on Mental Health and Mental Illness in Orthopaedic Surgery

“…This demonstrates a greater degree of concern for how these mental illnesses affect outcomes rather than on the impact of orthopaedic surgery on patients' psychological state. However, it is important to understand how orthopaedic surgery or injury affects consequent patient mental health because postoperatively developed mental health conditions have been shown to worsen long-term outcomes 28 , and mental health conditions have been shown to increase risk for future orthopaedic injuries and revision surgeries 29,30 . In other words, a circular reasoning exists: If one can understand and prevent the mental health sequelae of orthopaedic surgery and injury, one may in turn prevent the poor outcomes associated with these mental health conditions.…”