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

Benjamin C. Mayo Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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Dustin H. Massel Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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Daniel D. Bohl Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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Ankur S. Narain Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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Fady Y. Hijji Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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William W. Long Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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Krishna D. Modi Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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Bryce A. Basques Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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Alem Yacob Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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Kern Singh Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois

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OBJECTIVE

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).

METHODS

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.

RESULTS

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 < 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 > 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 > 0.05 for each).

CONCLUSIONS

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.

ABBREVIATIONS

ACDF = anterior cervical discectomy and fusion; CCI = Charlson Comorbidity Index; MCID = minimum clinically important difference; MCS = Mental Component Summary; NDI = Neck Disability Index; PCS = Physical Component Summary; PRO = patient-reported outcome; VAS = visual analog scale.
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  • 1

    Adogwa O, Parker SL, Shau DN, Mendenhall SK, Aaronson OS, Cheng JS, et al.: Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. Spine J 12:179185, 2012

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

    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
  • 3

    Adogwa O, Verla T, Thompson P, Penumaka A, Kudyba K, Johnson K, et al.: Affective disorders influence clinical outcomes after revision lumbar surgery in elderly patients with symptomatic adjacent-segment disease, recurrent stenosis, or pseudarthrosis: clinical article. J Neurosurg Spine 21:153159, 2014

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

    Alvin MD, Miller JA, Sundar S, Lockwood M, Lubelski D, Nowacki AS, et al.: The impact of preoperative depression on quality of life outcomes after posterior cervical fusion. Spine J 15:7985, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Andersen T, Christensen FB, Bünger C: Evaluation of a Dallas Pain Questionnaire classification in relation to outcome in lumbar spinal fusion. Eur Spine J 15:16711685, 2006

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

    Arpino L, Iavarone A, Parlato C, Moraci A: Prognostic role of depression after lumbar disc surgery. Neurol Sci 25:145147, 2004

  • 7

    Block AR, Ohnmeiss DD, Guyer RD, Rashbaum RF, Hochschuler SH: The use of presurgical psychological screening to predict the outcome of spine surgery. Spine J 1:274282, 2001

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

    Brodsky AE, Khalil MA, Sassard WR, Newman BP: Repair of symptomatic pseudoarthrosis of anterior cervical fusion. Posterior versus anterior repair. Spine (Phila Pa 1976) 17:11371143, 1992

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

    Cannada LK, Scherping SC, Yoo JU, Jones PK, Emery SE: Pseudoarthrosis of the cervical spine: a comparison of radiographic diagnostic measures. Spine (Phila Pa 1976) 28:4651, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Chaichana KL, Mukherjee D, Adogwa O, Cheng JS, McGirt MJ: Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy. J Neurosurg Spine 14:261267, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Chalmers I: Underreporting research is scientific misconduct. JAMA 263:14051408, 1990

  • 12

    Chapin L, Ward K, Ryken T: Preoperative depression, smoking, and employment status are significant factors in patient satisfaction after lumbar spine surgery. J Spinal Disord Tech [epub ahead of print] 2015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Dwan K, Altman DG, Arnaiz JA, Bloom J, Chan AW, Cronin E, et al.: Systematic review of the empirical evidence of study publication bias and outcome reporting bias. PLoS One 3:e3081, 2008

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

    Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR: Publication bias in clinical research. Lancet 337:867872, 1991

  • 15

    Elder BD, Sankey EW, Theodros D, Bydon M, Rory Goodwin C, Lo SF, et al.: Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis. J Clin Neurosci 24:5762, 2016

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

    Elsamadicy AA, Adogwa O, Cheng J, Bagley C: Pretreatment of depression before cervical spine surgery improves patients' perception of postoperative health status: a retrospective, single institutional experience. World Neurosurg 87:214219, 2016

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

    Farivar SS, Cunningham WE, Hays RD: Correlated physical and mental health summary scores for the SF-36 and SF-12 Health Survey, V.I. Health Qual Life Outcomes 5:54, 2007

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

    Forero CG, Vilagut G, Adroher ND, Alonso J: Multidimensional item response theory models yielded good fit and reliable scores for the Short Form-12 questionnaire. J Clin Epidemiol 66:790801, 2013

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

    Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al.: Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51:11711178, 1998

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

    He J, Xiong W, Li F, Luo W, Gao S: Depression influences pain and function after cervical disc arthroplasty. J Neurosurg Sci [epub ahead of print] 2014

  • 21

    Herron LD, Turner J, Clancy S, Weiner P: The differential utility of the Minnesota Multiphasic Personality Inventory. A predictor of outcome in lumbar laminectomy for disc herniation versus spinal stenosis. Spine (Phila Pa 1976) 11:847850, 1986

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

    Kang SS, Lee JS, Shin JK, Lee JM, Youn BH: The association between psychiatric factors and the development of chronic dysphagia after anterior cervical spine surgery. Eur Spine J 23:16941698, 2014

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

    Katz JN, Lipson SJ, Brick GW, Grobler LJ, Weinstein JN, Fossel AH, et al.: Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 20:11551160, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    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
  • 25

    Kjellby-Wendt G, Styf JR, Carlsson SG: The predictive value of psychometric analysis in patients treated by extirpationof lumbar intervertebral disc herniation. J Spinal Disord 12:375379, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    LaCaille RA, DeBerard MS, Masters KS, Colledge AL, Bacon W: Presurgical biopsychosocial factors predict multidimensional patient: outcomes of interbody cage lumbar fusion. Spine J 5:7178, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Li S, Qi M, Yuan W, Chen H: The impact of the depression and anxiety on prognosis of cervical total disc replacement. Spine (Phila Pa 1976) 40:E266E271, 2015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Liebeskind DS, Kidwell CS, Sayre JW, Saver JL: Evidence of publication bias in reporting acute stroke clinical trials. Neurology 67:973979, 2006

  • 29

    Littner Y, Mimouni FB, Dollberg S, Mandel D: Negative results and impact factor: a lesson from neonatology. Arch Pediatr Adolesc Med 159:10361037, 2005

  • 30

    McKillop AB, Carroll LJ, Battié MC: Depression as a prognostic factor of lumbar spinal stenosis: a systematic review. Spine J 14:837846, 2014

  • 31

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

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Miller JA, Derakhshan A, Lubelski D, Alvin MD, McGirt MJ, Benzel EC, et al.: The impact of preoperative depression on quality of life outcomes after lumbar surgery. Spine J 15:5864, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Ng LC, Tafazal S, Sell P: The effect of duration of symptoms on standard outcome measures in the surgical treatment of spinal stenosis. Eur Spine J 16:199206, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Pakarinen M, Vanhanen S, Sinikallio S, Aalto T, Lehto SM, Airaksinen O, et al.: Depressive burden is associated with a poorer surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study. Spine J 14:23922396, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Parker SL, Godil SS, Shau DN, Mendenhall SK, McGirt MJ: Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: clinical article. J Neurosurg Spine 18:154160, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Parker SL, Godil SS, Zuckerman SL, Mendenhall SK, Devin CJ, McGirt MJ: Extent of preoperative depression is associated with return to work after lumbar fusion for spondylolisthesis. World Neurosurg 83:608613, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Skeppholm M, Fransson R, Hammar M, Olerud C: The association between preoperative mental distress and patient reported outcome measures in patients treated surgically for cervical radiculopathy. Spine J [epub ahead of print] 2016

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Sundseth J, Kolstad F, Johnsen LG, Pripp AH, Nygaard OP, Andresen H, et al.: The Neck Disability Index (NDI) and its correlation with quality of life and mental health measures among patients with single-level cervical disc disease scheduled for surgery. Acta Neurochir (Wien) 157:18071812, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Trief PM, Ploutz-Snyder R, Fredrickson BE: Emotional health predicts pain and function after fusion: a prospective multicenter study. Spine (Phila Pa 1976) 31:823830, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Vilagut G, Forero CG, Pinto-Meza A, Haro JM, de Graaf R, Bruffaerts R, et al.: The mental component of the Short-Form 12 Health Survey (SF-12) as a measure of depressive disorders in the general population: results with three alternative scoring methods. Value Health 16:564573, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41

    Zong Y, Xue Y, Zhao Y, Ding H, He D, Li Z, et al.: Depression contributed an unsatisfactory surgery outcome among the posterior decompression of the cervical spondylotic myelopathy patients: a prospective clinical study. Neurol Sci 35:13731379, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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