Influence of depression symptoms on patient expectations and clinical outcomes in the surgical management of spinal stenosis

Alejandro Urban-Baeza Spine Surgery Service and

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Barón Zárate-Kalfópulos Spine Surgery Service and

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Samuel Romero-Vargas Spine Surgery Service and

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Claudia Obil-Chavarría Spine Surgery Service and

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Luis Brenes-Rojas Spine Surgery Service and

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Alejandro Reyes-Sánchez Head Special Surgery Division, Instituto Nacional de Rehabilitación, Tlalpan, México

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OBJECT

This prospective cohort study was designed to determine the influence of depressive symptoms on patient expectations and the clinical outcomes of the surgical management of lumbar spinal stenosis.

METHODS

Patients with an age > 45 years, a diagnosis of lumbar spinal stenosis at one level, and an indication for decompressive surgery were included in this study. Data for all of the following parameters were recorded: age, sex, highest level of education, and employment status. Depression symptoms (Beck Depression Inventory), disability (Oswestry Disability Index), and back and leg pain (visual analog scale) were assessed before surgery and at 12 months thereafter. The reasons for surgery and patient expectations (North American Spine Society lumbar spine questionnaire) were noted before surgery. The global effectiveness of surgery (Likert scale) was assessed at the 1-year follow-up.

RESULTS

Fifty-eight patients were divided into two groups based on the presence (Group 1) or absence (Group 2) of depressive symptoms preoperatively; each group comprised 29 patients. Demographic data were similar in both groups before surgery. The main reason to undergo surgery was “fear of a worse situation” in 34% of the patients in Group 1 and “to reduce pain” in 24% of the patients in Group 2. The most prevalent expectation was to improve my social life and my mental health in both groups. Surgery had a relieving effect on the depressive symptoms in 14 patients (48%). Thus, in the postoperative period, the number of patients who were free of depressive symptoms was 43 compared with the 15 who were depressed (p = 0.001). The 15 patients with persistent depression symptoms after surgery had a worse clinical outcome compared with the 43 patients free of depression symptoms at the 1-year follow-up in terms of severe back pain (20% vs 0%, respectively), severe leg pain (40% vs 2.3%, respectively), and severe disability (53% vs 9.3%, respectively). Only 33% of patients with persistent depression symptoms after surgery chose the option “surgery helped a lot” compared with 76% of patients without depression symptoms. Moreover, in terms of expectations regarding improvement in back pain, leg pain, walking capacity, independence, physical duties, and social activities, fewer patients were “completely satisfied” in the group with persistent depression symptoms after surgery.

CONCLUSIONS

Surgery for spinal stenosis had a relieving effect on preoperative depression symptoms at the 1-year follow-up. The persistence of depressive symptoms after surgery correlated with a worse clinical outcome and a higher rate of unmet expectations. Screening measures to detect and treat depression symptoms in the perioperative period could lead to better clinical results and increased patient satisfaction.

ABBREVIATIONS

BDI = Beck Depression Inventory; NASS = North American Spine Society; ODI = Oswestry Disability Index; VAS = visual analog scale.
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  • 1

    Aalto TJ, , Malmivaara A, , Kovacs F, , Herno A, , Alen M, & Salmi L, et al.: Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine (Phila Pa 1976) 31:E648E663, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Abbott AD, , Tyni-Lenné R, & Hedlund R: Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery. Eur Spine J 20:16261634, 2011

  • 3

    Adogwa O, , Parker SL, , Shau DN, , Mendenhall SK, , Bydon A, & Cheng JS, et al.: Preoperative Zung depression scale predicts patient satisfaction independent of the extent of improvement after revision lumbar surgery. Spine J 13:501506, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Beck AT, , Ward CH, , Mendelson M, , Mock J, & Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 4:561571, 1961

  • 5

    Daltroy LH, , Cats-Baril WL, , Katz JN, , Fossel AH, & Liang MH: The North American Spine Society lumbar Spine Outcome Assessment Instrument: reliability and validity tests. Spine (Phila Pa 1976) 21:741749, 1996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Fairbank JC, & Pynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:29402952, 2000

  • 7

    Godil SS, , Parker SL, , Zuckerman SL, , Mendenhall SK, , Devin CJ, & Asher AL, et al.: Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy. Spine J 13:10061012, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Katz JN, , Stucki G, , Lipson SJ, , Fossel AH, , Grobler LJ, & Weinstein JN: Predictors of surgical outcome in degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 24:22292233, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Lattig F, , Fekete TF, , O'Riordan D, , Kleinstück FS, , Jeszenszky D, & Porchet F, et al.: A comparison of patient and surgeon preoperative expectations of spinal surgery. Spine (Phila Pa 1976) [epub ahead of print] 2012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Licina P, , Johnston M, , Ewing L, & Pearcy M: Patient expectations, outcomes and satisfaction: related, relevant or redundant?. Evid Based Spine Care J 3:1319, 2012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Lutz GK, , Butzlaff ME, , Atlas SJ, , Keller RB, , Singer DE, & Deyo RA: The relation between expectations and outcomes in surgery for sciatica. J Gen Intern Med 14:740744, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Mannion AF, , Junge A, , Elfering A, , Dvorak J, , Porchet F, & Grob D: Great expectations: really the novel predictor of outcome after spinal surgery?. Spine (Phila Pa 1976) 34:15901599, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Mariconda M, , Zanforlino G, , Celestino GA, , Brancaleone S, , Fava R, & Milano C: Factors influencing the outcome of degenerative lumbar spinal stenosis. J Spinal Disord 13:131137, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    McGregor AH, , Doré CJ, & Morris TP: An exploration of patients' expectation of and satisfaction with surgical outcome. Eur Spine J 22:28362844, 2013

  • 15

    McGregor AH, & Hughes SPF: The evaluation of the surgical management of nerve root compression in patients with low back pain: Part 2: patient expectations and satisfaction. Spine (Phila Pa 1976) 27:14711477, 2002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Menendez M, , Neuhaus V, , Bot A, , Ring D, & Cha TD: Psychiatric disorders and major spine surgery: epidemiology and perioperative outcomes. Spine (Phila Pa 1976) 39:E111E122, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Sinikallio S, , Aalto T, , Airaksinen O, , Herno A, , Kröger H, & Savolainen S, et al.: Depression and associated factors in patients with lumbar spinal stenosis. Disabil Rehabil 28:415422, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Sinikallio S, , Aalto T, , Airaksinen O, , Herno A, , Kröger H, & Viinamäki H: Depressive burden in the preoperative and early recovery phase predicts poorer surgery outcome among lumbar spinal stenosis patients: a one-year prospective follow-up study. Spine (Phila Pa 1976) 34:25732578, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Sinikallio S, , Aalto T, , Airaksinen O, , Lehto SM, , Kröger H, & Viinamäki H: Depression is associated with a poorer outcome of lumbar spinal stenosis surgery: a two-year prospective follow-up study. Spine (Phila Pa 1976) 36:677682, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Skolasky RL, , Riley LH III, , Maggard AM, & Wegener ST: The relationship between pain and depressive symptoms after lumbar spine surgery. Pain 153:20922096, 2012

  • 21

    Soroceanu A, , Ching A, , Abdu W, & McGuire K: Relationship between preoperative expectations, satisfaction, and functional outcomes in patients undergoing lumbar and cervical spine surgery: a multicenter study. Spine (Phila Pa 1976) 37:E103E108, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Sriwatanakul K, , Kelvie W, , Lasagna L, , Calimlim JF, , Weis OF, & Mehta G: Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther 34:234239, 1983

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Tharin S, , Mayer E, & Krishnaney A: Lumbar microdiscectomy and lumbar decompression improve functional outcomes and depression scores. Evid Based Spine Care J 3:6566, 2012

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Toyone T, , Tanaka T, , Kato D, , Kaneyama R, & Otsuka M: Patients' expectations and satisfaction in lumbar spine surgery. Spine (Phila Pa 1976) 30:26892694, 2005

  • 25

    Wahlman M, , Häkkinen A, , Dekker J, , Marttinen I, , Vihtonen K, & Neva M: The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion. Eur Spine J 23:129134, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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