Impact of Prolonged Duration of Symptoms on Mental Health in Anterior Cervical Disectomy and Fusion Patients

Abstract

Introduction: Prolonged duration of symptoms is associated with worse pain and disability in patients undergoing anterior cervical discectomy and fusion (ACDF). Our study aims to determine the effect of symptom duration on severity of depression among ACDF patients. Methods: We retrospectively reviewed a prospective surgical database from 2006 to 2019 for primary, single, or multilevel ACDF. Patients missing the duration of symptom information or patient-reported outcome measures (PROMs) were excluded. PROMs included Patient Health Questionnaire-9, 12-Item Short Form Mental Component Score, and 12-Item Veterans RAND Mental Component Score and were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year timepoints. The minimum clinically important difference (MCID) was calculated using the established values. Patients were categorized based on preoperative duration of symptoms as follows: <6 months, ≥6 months and <1 year, 1 to 2 years, and >2 years. Univariate analysis was done to determine differences in demographics and perioperative characteristics. Intergroup differences in PROMs and MCID achievement were evaluated using linear regression and logistic regression, respectively. Results: Two hundred thirty-one ACDF patients included had a mean age of 49.6 years and most were male (61.0%) and nonobese (<30 kg/m2; 55.0%). The groups differed by their American Society of Anesthesiologists classification (P = 0.029), workers' compensation status (P = 0.022), and diagnosis of herniated nucleus pulposus (P = 0.010). Postoperative mental health outcomes did not significantly differ between duration groups except for Veterans Rand-12 Mental Component Score at 12 weeks (P = 0.044). MCID achievement rates did not significantly differ. Conclusion: Patients undergoing ACDF largely did not demonstrate differences in mental health scores or achievement of MCID based on the duration of symptoms.

COVID-19 disruptions to elective postoperative care did not adversely affect early complications or patient reported outcomes of primary TKA

“…These differences fell below the KOOS JR minimum clinically important difference (MCID) of 6 [ 17 ]. VR-12 mental scores were equal between study and control cohorts for all collection intervals except at 1 year (54 vs. 56.4; p = 0.002), but this disparity similarly fell below an MCID of 6.5 [ 18 ]. VR-12 physical scores were equal between cohorts for all intervals except at 6 weeks (35.4 vs. 33.3; p = 0.005), with differences also falling below an MCID of 3 [ 19 ].…”

“…Differences between KOOS JR scores again fell below an MCID of 6 [ 17 ]. An inverse effect was observed for ΔVR-12 mental ( – 2.4 vs. – 0.1; p = 0.01) and LEAS at 1 year (0.3 vs. 1.6; p < 0.001) (Table 5 ), with VR-12 differences falling below MCID [ 18 ].…”

Long-Term (>24 Months) Duration of Symptoms Negatively Impacts Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy

“…Wichmann et al 16 found less postoperative satisfaction in patients with DOS > 3 months. Finally, Lynch et al 17 investigated mental health and largely found no difference in outcomes with longer DOS. Our data reported trends consistent with several of these prior publications.…”

“…In the lumbar radiculopathy literature, there is evidence to suggest that longer symptom duration is associated with worse health-related quality of life (HRQoL) measures. [6][7][8][9][10] For cervical radiculopathy, there is some evidence to suggest the same relation, [11][12][13][14][15][16][17] but the conclusions have been inconsistent. This long preoperative wait time in Canada presents a unique opportunity to analyze the impact of the preoperative duration of symptoms on HRQoL in patients with cervical radiculopathy.…”