Effect of depression and anxiety on health-related quality of life outcomes and patient satisfaction after surgery for cervical compressive myelopathy

Restricted access

OBJECTIVE

Preoperative mood disorders such as depression and anxiety are known to be associated with poor health-related quality of life (HRQOL) outcomes after lumbar spine surgery. However, the effects of preoperative depression and anxiety on postoperative HRQOL outcomes and patient satisfaction in cervical compressive myelopathy are yet to be clarified. This study aimed to investigate the effect of depression and anxiety on HRQOL outcomes and patient satisfaction following surgery for cervical compressive myelopathy.

METHODS

The authors reviewed the cases of all consecutive patients with cervical compressive myelopathy who had undergone surgical treatment in the period between January 2012 and March 2017 at their institution. Using the Hospital Anxiety and Depression Scale (HADS), the authors classified patients as depressed (HADS-D+) or not depressed (HADS-D−) and anxious (HADS-A+) or not anxious (HADS-A−). Patient HRQOL was evaluated preoperatively and at the end of at least 1 year after surgery using the physical and mental component summaries of the SF-12 Health Survey, EQ-5D (EuroQol health survey of five dimensions), Neck Disability Index, and Japanese Orthopaedic Association scale. Patient satisfaction was evaluated on the basis of a seven-item questionnaire and divided into two categories: satisfied and dissatisfied. Preoperative HRQOL statuses, postoperative improvements in HRQOL outcomes, and patient satisfaction were compared between the groups.

RESULTS

Among the 121 patients eligible for inclusion in the study, there were 69 patients (57.0%) without depression (HADS-D−) and 52 (43.0%) with depression (HADS-D+) and 82 patients (67.8%) without anxiety (HADS-A−) and 39 (32.2%) with anxiety (HADS-A+). All patients who completed both the preoperative and postoperative questionnaires had significant postoperative improvements in all HRQOL outcomes. The HADS-D+ and HADS-A+ patients had poorer preoperative HRQOL statuses than the HADS-D− and HADS-A− patients, respectively. However, statistically significant improvements in all HRQOL outcomes were observed in both HADS-D+ and HADS-A+ patients. Patient satisfaction was comparable between the HADS-D or HADS-A groups.

CONCLUSIONS

Cervical compressive myelopathy patients with preoperative depression or anxiety according to the HADS tool had worse preoperative HRQOL statuses. However, patients with cervical compressive myelopathy showed significant improvements in HRQOL outcomes and had sufficient levels of satisfaction after surgery regardless of the presence of preoperative depression or anxiety.

ABBREVIATIONS ADF = anterior cervical decompression and fusion; ADL = activity of daily living; CSM = cervical spondylotic myelopathy; HADS = Hospital Anxiety and Depression Scale; HADS-A = HADS-Anxiety; HADS-D = HADS-Depression; HRQOL = health-related quality of life; JOA = Japanese Orthopaedic Association; MCS = Mental Component Summary; NDI = Neck Disability Index; OPLL = ossification of the posterior longitudinal ligament; PCS = Physical Component Summary; PDF = posterior cervical decompression and fusion.
Article Information

Contributor Notes

Correspondence Yasushi Oshima: University of Tokyo, Japan. yoo-tky@umin.ac.jp.INCLUDE WHEN CITING Published online September 13, 2019; DOI: 10.3171/2019.6.SPINE19569.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Abumi K: Cervical spondylotic myelopathy: posterior decompression and pedicle screw fixation. Eur Spine J 24 (Suppl 2):1861962015

  • 2

    Bjelland IDahl AAHaug TTNeckelmann D: The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52:69772002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Boogaarts HDBartels RH: Prevalence of cervical spondylotic myelopathy. Eur Spine J 24 (Suppl 2):1391412015

  • 4

    Cochran WG: The chi-square test of goodness of fit. Ann Math Stat 25:3153451952

  • 5

    Falavigna ARighesso OTeles ARBaseggio NVelho MCRuschel LG: Depression Subscale of the Hospital Anxiety and Depression Scale applied preoperatively in spinal surgery. Arq Neuropsiquiatr 70:3523562012

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

    Fehlings MGTetreault LAWilson JRSkelly AC: Cervical spondylotic myelopathy: current state of the art and future directions. Spine (Phila Pa 1976) 38 (22 Suppl 1):S1S82013

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Goh GSLiow MHLYeo WLing ZMGuo CMYue WM: Poor baseline mental health does not influence improvement in patient-reported outcomes, satisfaction, and return to work two years after single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 44:8398472019

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

    Iwasaki MOkuda SMiyauchi ASakaura HMukai YYonenobu K: Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty. Spine (Phila Pa 1976) 32:6476532007

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

    Karpova AArun RDavis AMKulkarni AVMassicotte EMMikulis DJ: Predictors of surgical outcome in cervical spondylotic myelopathy. Spine (Phila Pa 1976) 38:3924002013

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

    Li SQi MYuan WChen H: The impact of the depression and anxiety on prognosis of cervical total disc replacement. Spine (Phila Pa 1976) 40:E266E2712015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Liu TXu WCheng TYang HL: Anterior versus posterior surgery for multilevel cervical myelopathy, which one is better? A systematic review. Eur Spine J 20:2242352011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    MacDowall ARobinson YSkeppholm MOlerud C: Anxiety and depression affect pain drawings in cervical degenerative disc disease. Ups J Med Sci 122:991072017

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

    Marquez-Lara ANandyala SVFineberg SJSingh K: Incidence, outcomes, and mortality of reintubation after anterior cervical fusion. Spine (Phila Pa 1976) 39:1341392014

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

    Miller JADerakhshan ALubelski DAlvin MDMcGirt MJBenzel EC: The impact of preoperative depression on quality of life outcomes after lumbar surgery. Spine J 15:58642015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Moussavi SChatterji SVerdes ETandon APatel VUstun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370:8518582007

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

    Nouri ATetreault LSingh AKaradimas SKFehlings MG: Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976) 40:E675E6932015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Ohya JOshima YOka HSaiki FTaniguchi YMatsubayashi Y: Patient satisfaction with posterior decompression surgery for cervical ossification of the posterior longitudinal ligament: prognostic radiographic factors and patient-reported outcomes for the effectiveness of surgical treatment. World Neurosurg 96:2722792016

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

    Oichi TOshima YTaniguchi YMatsubayashi YChikuda HTakeshita K: Cervical anterolisthesis: a predictor of poor neurological outcomes in cervical spondylotic myelopathy patients after cervical laminoplasty. Spine (Phila Pa 1976) 41:E467E4732016

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Rapaport MHClary CFayyad REndicott J: Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry 162:117111782005

  • 20

    Seichi ATakeshita KOhishi IKawaguchi HAkune TAnamizu Y: Long-term results of double-door laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976) 26:4794872001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Singh AMisra N: Loneliness, depression and sociability in old age. Ind Psychiatry J 18:51552009

  • 22

    Sinikallio SAalto TAiraksinen OHerno AKröger HSavolainen S: Depression is associated with poorer outcome of lumbar spinal stenosis surgery. Eur Spine J 16:9059122007

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

    Skeppholm MFransson RHammar MOlerud C: The association between preoperative mental distress and patient-reported outcome measures in patients treated surgically for cervical radiculopathy. Spine J 17:7907982017

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

    Suda KAbumi KIto MShono YKaneda KFujiya M: Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 28:125812622003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Tetreault LNagoshi NNakashima HSingh AKopjar BArnold P: Impact of depression and bipolar disorders on functional and quality of life outcomes in patients undergoing surgery for degenerative cervical myelopathy: analysis of a combined prospective dataset. Spine (Phila Pa 1976) 42:3723782017

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

    Tetreault LAKarpova AFehlings MG: Predictors of outcome in patients with degenerative cervical spondylotic myelopathy undergoing surgical treatment: results of a systematic review. Eur Spine J 24 (Suppl 2):2362512015

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

    Trief PMGrant WFredrickson B: A prospective study of psychological predictors of lumbar surgery outcome. Spine (Phila Pa 1976) 25:261626212000

  • 28

    Tsang AVon Korff MLee SAlonso JKaram EAngermeyer MC: Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain 9:8838912008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Vernon HMior S: The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther 14:4094151991

  • 30

    Wilhelm MReiman MGoode ARichardson WBrown CVaughn D: Psychological predictors of outcomes with lumbar spinal fusion: a systematic literature review. Physiother Res Int 22:222017

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31

    Yonenobu KOkada KFuji TFujiwara KYamashita KOno K: Causes of neurologic deterioration following surgical treatment of cervical myelopathy. Spine (Phila Pa 1976) 11:8188231986

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Zigmond ASSnaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 67:3613701983

TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 321 321 131
Full Text Views 60 60 29
PDF Downloads 26 26 13
EPUB Downloads 0 0 0
PubMed
Google Scholar