Outcome of spine surgery in patients with depressed mental states: a Canadian spine outcome research network study

Cushnie, Duncan; Soroceanu, Alex; Stratton, Alexandra; Dea, Nicolas; Finkelstein, Joel; Bailey, Christopher S.; Weber, Michael H.; Paquet, Jérôme; Glennie, R. Andrew; Hall, Hamilton; Rampersaud, Raja; Ahn, Henry; Kelly, Adrienne; Christie, Sean; Nataraj, Andrew; Johnson, Michael G.; Abraham, Ed; Attabib, Najmedden; Fisher, Charles G.; Manson, Neil; Thomas, Kenneth

doi:10.1016/j.spinee.2022.05.012

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…88 The initiative recommends the use of Patient Health Questionnaire-9 (PHQ-9) for depression screening in primary care settings. 89 However, only 4 of 37 studies (10%) used PHQ-9, 7,8,36,42 emphasizing the need to standardize practices in spine surgery research.…”

Section: Discussionmentioning

confidence: 99%

“…Among these studies, 44 met the eligibility criteria; each study is described in eTable 5 in Supplement 1. [6][7][8][14][15][16][17][18] Overall, 21 452 patients were included, of whom there were 11 747 females (55%) and 9705 males (45%) with a mean (SD) age of 57 (8) years. Two studies involved a mix of lumbar and cervical populations and were excluded from all quantitative meta-analyses.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[3][4][5] A large number of studies have shown that a subset of patients who undergo spine surgery present with comorbid psychiatric disorders such as depression and/or anxiety. [6][7][8] It is well established that comorbid depression affects the severity of low back pain symptoms and treatment outcomes. 9,10 Consequently, the association between depression and back pain has been a major focus of personalized treatment studies of the National Institutes of Health Back Pain Consortium.…”

Section: Introductionmentioning

confidence: 99%

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Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

Javeed,

Benedict,

Yakdan

et al. 2024

JAMA Netw Open

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ImportanceComorbid depression is common among patients with degenerative lumbar spine disease. Although a well-researched topic, the evidence of the role of depression in spine surgery outcomes remains inconclusive.ObjectiveTo investigate the association between preoperative depression and patient-reported outcome measures (PROMs) after lumbar spine surgery.Data SourcesA systematic search of PubMed, Cochrane Database of Systematic Reviews, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov was performed from database inception to September 14, 2023.Study SelectionIncluded studies involved adults undergoing lumbar spine surgery and compared PROMs in patients with vs those without depression. Studies evaluating the correlation between preoperative depression and disease severity were also included.Data Extraction and SynthesisAll data were independently extracted by 2 authors and independently verified by a third author. Study quality was assessed using Newcastle-Ottawa Scale. Random-effects meta-analysis was used to synthesize data, and I2 was used to assess heterogeneity. Metaregression was performed to identify factors explaining the heterogeneity.Main Outcomes and MeasuresThe primary outcome was the standardized mean difference (SMD) of change from preoperative baseline to postoperative follow-up in PROMs of disability, pain, and physical function for patients with vs without depression. Secondary outcomes were preoperative and postoperative differences in absolute disease severity for these 2 patient populations.ResultsOf the 8459 articles identified, 44 were included in the analysis. These studies involved 21 452 patients with a mean (SD) age of 57 (8) years and included 11 747 females (55%). Among these studies, the median (range) follow-up duration was 12 (6-120) months. The pooled estimates of disability, pain, and physical function showed that patients with depression experienced a greater magnitude of improvement compared with patients without depression, but this difference was not significant (SMD, 0.04 [95% CI, −0.02 to 0.10]; I2 = 75%; P = .21). Nonetheless, patients with depression presented with worse preoperative disease severity in disability, pain, and physical function (SMD, −0.52 [95% CI, −0.62 to −0.41]; I2 = 89%; P &lt; .001), which remained worse postoperatively (SMD, −0.52 [95% CI, −0.75 to −0.28]; I2 = 98%; P &lt; .001). There was no significant correlation between depression severity and the primary outcome. A multivariable metaregression analysis suggested that age, sex (male to female ratio), percentage of comorbidities, and follow-up attrition were significant sources of variance.Conclusions and RelevanceResults of this systematic review and meta-analysis suggested that, although patients with depression had worse disease severity both before and after surgery compared with patients without depression, they had significant potential for recovery in disability, pain, and physical function. Further investigations are needed to examine the association between spine-related disability and depression as well as the role of perioperative mental health treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

Javeed,

Benedict,

Yakdan

et al. 2024

JAMA Netw Open

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“…According to several research studies, the preoperative mental condition influences the postoperative outcomes in spine surgery. 8,13,34,40 The most relevant predictor of residual lower back pain and leg pain, as well as the possibility of still being sick 1 year after the surgery, were predicted by questions that assessed the patient's expectations and thoughts. Indeed, being classified at high risk of FAB preoperatively and being a woman significantly increased the risk of having low quality of life 1 year after the surgery.…”

Section: Role Of Preoperative Fear-avoidance Beliefs Questionnaire On...mentioning

confidence: 99%

“…8 In this sense, psychosocial factors have been identified as key players in the chronicity process of pain and disability, 25,32 which can contribute to long-lasting functional brain changes and may partially explain the perpetuation of symptoms after suppressing the nociceptive source. 14 In the context of spine surgery, psychosocial factors, such as distress, depression, or anxiety, 2,13,15,42 are considered risk factors that may contribute to the variability of surgical outcomes. 9 However, factors such as kinesiophobia or fearavoidance beliefs (FABs) are understudied, and their impact on recovery after surgery is still unclear.…”

Section: Introductionmentioning

confidence: 99%

The burden of preoperative fear-avoidance beliefs in workers after thoracic and lumbar spine surgery: a 2-year follow-up study

Bellosta-López

Langella

Ponzo

et al. 2023

PAIN

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Spinal disorders are the main reasons for sick leave and early retirement among the working population in industrialized countries. When “red flags” are present, spine surgery is the treatment of choice. However, the role of psychosocial factors such as fear-avoidance beliefs in spine surgery outcomes is still debated. The study aims to investigate whether patients presenting high or low levels of fear-avoidance thoughts before the spine surgery reported different surgical results and return-to-work rates over 2 years. From an institutional spine surgery registry, workers surgically treated with a preoperative score in the Oswestry Disability Index (ODI) higher than 20/100 and provided ODI questionnaires, return-to-work status at 3-, 6-, 12-, and 24-month follow-ups were analyzed. A total of 1769 patients were stratified according to the work subscale of the Fear-Avoidance Beliefs Questionnaire (FABQ-W) in high fear (FABQ-W ≥ 34/42) or low fear (FABQ-W < 34/42). Multivariate regression was used to search for preoperative factors, which might interact with FABQ-W. The higher-fear group showed a different recovery pattern, with higher levels of disability according to the ODI (total score, absolute change, frequency of clinically relevant change, and disability categories) and lower return-to-work ratios over the 24-month follow-up. High fear, high disability, greater age, female gender, smoking, and worse physical status at baseline were associated with worse ODI outcomes 2 years after the surgery. In summary, fear-avoidance beliefs significantly influence the speed and the entity of surgical outcomes in the working population. However, the contribution of FABQ-W in predicting long-term disability levels was limited.

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Allgemeine Aspekte in präoperativen – intraoperativen – postoperativen Abschnitten

Kapfhammer

2023

Depression, Angst Und Traumatischer Stress in Der Chirurgie

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Outcome of spine surgery in patients with depressed mental states: a Canadian spine outcome research network study

Cited by 8 publications

References 18 publications

Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

The burden of preoperative fear-avoidance beliefs in workers after thoracic and lumbar spine surgery: a 2-year follow-up study

Allgemeine Aspekte in präoperativen – intraoperativen – postoperativen Abschnitten

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