Depression Increases Posterior Cervical Decompression and Fusion Revision Rates and Diminishes Neck Disability Index Improvement. Issue 18 (15th September 2022)

• Record Type: Journal Article
• Authors: Toci, Gregory R.; Lambrechts, Mark J.; Karamian, Brian A.; Mao, Jennifer; Heinle, Jeremy; Bhatt, Shivang; Harlamova, Daria; Canseco, Jose A.; Kaye, Ian David; Woods, Barrett I.; Hilibrand, Alan S.; Kepler, Christopher K.; Vaccaro, Alexander R.; Schroeder, Gregory D.
• Is Part Of: Spine. Volume 47:Issue 18(2022)
• Page Start: 1287
• Page End: 1294
• Publication Date: 2022-09-15
• Subjects: posterior cervical fusion -- spine surgery -- patient reported outcome measures -- clinical outcomes -- depression -- anxiety; Level 3; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000004371
• Languages: English
• ISSNs: 0362-2436

Abstract

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. χ 2 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.