Preoperative mental health status may not be predictive of improvements in patient-reported outcomes following an anterior cervical discectomy and fusion

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Prior studies have correlated preoperative depression and poor mental health status with inferior patient-reported outcomes following lumbar spinal procedures. However, literature regarding the effect of mental health on outcomes following cervical spinal surgery is limited. As such, the purpose of this study is to test for the association of preoperative SF-12 Mental Component Summary (MCS) scores with improvements in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), and neck and arm pain following anterior cervical discectomy and fusion (ACDF).</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A prospectively maintained surgical database of patients who underwent a primary 1- or 2-level ACDF during 2014–2015 was reviewed. Patients were excluded if they did not have complete patient-reported outcome data for the preoperative or 6-week, 12-week, or 6-month postoperative visits. At baseline, preoperative SF-12 MCS score was assessed for association with preoperative NDI, neck visual analog scale (VAS) score, arm VAS score, and SF-12 PCS score. The preoperative MCS score was then tested for association with changes in NDI, neck VAS, arm VAS, and SF-12 PCS scores from the preoperative visit to postoperative visits. These tests were conducted using multivariate regression controlling for baseline characteristics as well as for the preoperative score for the patient-reported outcome being assessed.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 52 patients were included in the analysis. At baseline, a higher preoperative MCS score was negatively associated with a lower preoperative NDI (coefficient: −0.74, p &lt; 0.001) and preoperative arm VAS score (−0.06, p = 0.026), but not preoperative neck VAS score (−0.03, p = 0.325) or SF-12 PCS score (0.04, p = 0.664). Additionally, there was no association between preoperative MCS score and improvement in NDI, neck VAS, arm VAS, or SF-12 PCS score at any of the postoperative time points (6 weeks, 12 weeks, and 6 months, p &gt; 0.05 for each). The percentage of patients achieving a minimum clinically important difference at 6 months did not differ between the bottom and top MCS score halves (p &gt; 0.05 for each).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The results of this study suggest that better preoperative mental health status is associated with lower perceived preoperative disability but is not associated with severity of preoperative neck or arm pain. In contrast to other studies, the present study was unable to demonstrate that preoperative mental health is predictive of improvement in patient-reported outcomes at any postoperative time point following an ACDF.</jats:p></jats:sec>

Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy

“…1,10,35 Most studies on patients with a cervical spine condition have reported associations between mental disability and less improvement after surgical treatment, even though the follow-up periods were short. 2,15,21,30 Interesting to note is that Mayo et al 24 failed to find such associations, which could be explained by the very short follow-up period (only 6 months) in that study. Persson and Lilja 29 discovered that although the patients in their study used active coping before surgery, they developed passive coping mechanisms after surgery to treat cervical radiculopathy; the authors therefore recommended a multidisciplinary rehabilitation program that includes cognitive behavioral therapy groups.…”

Psychological predictors of quality of life after anterior cervical discectomy and fusion for degenerative cervical spine disease

“…Despite the existence of numerous studies documenting QOL and functional outcomes after ACDF and a growing body of literature examining psychological scores in the context of lumbar spine surgery, there is considerably less evidence for the correlation between anxiety as well as depression and QOL outcomes after ACDF [13][14][15][16][17][18]39,[52][53][54][55][56][57] .…”

“…Notably, this study succeeded in identifying predictors of QOL improvements after ACDF surgery, but failed to delineate one explicit cut-off to identify the patients at risk for failure to improve. The SF-36 MCS predictor has been prominently featured in several other publications assessing the psychological profile in the setting of cervical and lumbar spine surgery, while the ASI-3 and STAI-S have not been identified before 12 , 14 , 64 – 66 .…”

Retrospective Data Analysis and Literature Review for a Development of Enhanced Recovery after Surgery Pathway for Anterior Cervical Discectomy and Fusion

“…In patients with anxiety, treatment before surgery results in significant reduction in postoperative neck pain [19]. On the other hand, a more recent study of 52 patients who underwent 1-or 2level ACDF failed to demonstrate a correlation between preoperative SF-12 Mental Component Summary (MCS) scores and improvement in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), or neck and arm pain [20]. While more research is necessary, for patients with an established psychiatric diagnosis, treatment compliance will be ensured prior to surgery to optimize recovery.…”