The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion

Wahlman, Marko; Häkkinen, Arja; Dekker, Joost; Marttinen, Ilkka; Vihtonen, Kimmo; Neva, Marko H.

doi:10.1007/s00586-013-2896-0

Cited by 46 publications

(48 citation statements)

References 27 publications

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“…Depressive symptoms have been shown to predict poorer surgical outcome after lumbar spine surgery [29][30][31][32][33], which finding is in accordance with our observation. To our knowledge, this is the first study to examine the role that different depression subtypes play in modifying the postoperative result after spinal surgery.…”

Section: Discussionsupporting

confidence: 95%

Depressive symptoms are associated with poor outcome for lumbar spine surgery

Järvimäki

Kautiainen

Haanpää

et al. 2016

Scandinavian Journal of Pain

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AbstractBackground and aimsThe symptoms of pain and depression often present concomitantly, but little is known as to how the different subtypes of depression affect surgical outcome. The aim of this study was to determine whether there is a difference in outcome after lumbar spine surgery between non-depressed patients and patients with different subtypes of depressive symptoms: non-melancholic (NmDS) and melancholic depression (MDS).MethodsThis was a cross-sectional postal survey. A self-made questionnaire, the Beck Depression Inventory (BDI) and the Oswestery Low Back Disability Questionnaire (ODI) were sent to patients who had undergone lumbar spine surgery in the Oulu University Hospital between June, 2005 and May, 2008. BDI ≤ 10 were further classified into NmDS or MDS.ResultsA total of 537 patients (66%) completed the survey. Of these, 361 (67%) underwent disc surgery, 85 (16%) stabilizing surgery and 91 (17%) decompression. Participants were divided into three groups: BDI< 10 N=324 (60%), NmDS N=153 (29%) and MDS N=60 (11%). The mean ODI (SD) in the BDI<1 0 group was 16 (15), in the NmDS group 36 (15), and in the MDS group 41 (18) (p<0.001). The ODI profiles were different between the groups (p<0.001). Pain was more frequent in depressive patients (88% of MDS, 81% in NmDS and 40% in BDI < 10 patients experienced pain, p<0.001). The intensity of pain and pain-related disability was lowest among the patients in the BDI <10 group and highest among the MDS patients. Regular pain medication was used by 87% of patients in the MDS group, 93% of patients in the NmDS group, and 71% of patients in the BDI< 10 group (p<0.001). Response to pain medication with NRS (0–10) was 5.6 among MDS, 5.8 among NmDS and 6.5 among BDI< 10 patients (p<0.001).ConclusionDifferent types of depressive symptoms are associated with poor outcome after lumbar spine surgery. The outcome was worst in patients suffering from the MDS subtype. This was observed in pain intensity, functional disability and response to pain medication.ImplicationIt would be important to evaluate depression pre- and postoperatively. Offering a tailored rehabilitation programme to MDS patients should be considered.© 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

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Section: Discussionsupporting

confidence: 95%

Depressive symptoms are associated with poor outcome for lumbar spine surgery

Järvimäki

Kautiainen

Haanpää

et al. 2016

Scandinavian Journal of Pain

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“…Patients living alone had more pain, which might be explained by the lack of disease-related support. There are similar reports involving other orthopedic conditions where psychological factors have affected the perception of pain (Wahlman et al 2014). Also, in shoulder complaints several psychological factors have been related to outcome (Bot et al 2005).…”

Section: Discussionsupporting

confidence: 63%

Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?

et al. 2015

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Background and purpose — Shoulder impingement syndrome is common, but treatment is controversial. Arthroscopic acromioplasty is popular even though its efficacy is unknown. In this study, we analyzed stage-II shoulder impingement patients in subgroups to identify those who would benefit from the operation.Patients and methods — In a previous randomized study, 140 patients were either treated with a supervised exercise program or with arthroscopic acromioplasty followed by a similar exercise program. The patients were followed up at 2 and 5 years after randomization. Self-reported pain was used as the primary outcome measure.Results — Both treatment groups had less pain at 2 and 5 years, and this was similar in both groups. Duration of symptoms, marital status (single), long periods of sick leave, and lack of professional education appeared to increase the risk of persistent pain despite the treatment. Patients with impingement with radiological acromioclavicular (AC) joint degeneration also had more pain. The patients in the exercise group who later wanted operative treatment and had it did not get better after the operation.Interpretation — The natural course probably plays a substantial role in the outcome. Based on our findings, it is difficult to recommend arthroscopic acromioplasty for any specific subgroup. Regarding operative treatment, however, a concomitant AC joint resection might be recommended if there are signs of AC joint degeneration. Even more challenging for the development of a treatment algorithm is the finding that patients who do not recover after nonoperative treatment should not be operated either.

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“…19 In another study of 232 patients who had undergone instrumented lumbar spine fusion, the authors noted that 32% of patients had preoperative depression symptoms but only 15% had them at the 1-year follow-up. 25 These researchers concluded that the prevalence of depressive symptoms decreased after surgery. Disability remained higher in patients who had reported depressive symptoms preoperatively but decreased significantly after surgery; thus, the authors suggested that there was no need to exclude depressive patients from surgery, although screening measures and appropriate treatment practices were encouraged.…”

Section: -19mentioning

confidence: 99%

“…1,2,[16][17][18][19][20]23,25 To our knowledge, there is no information in the literature concerning the influence of depression symptoms on patient expectations. We hypothesized that patient expectations can be affected by depression symptoms and, consequently, will affect clinical results.…”

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confidence: 99%

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

Urban-Baeza¹,

Zárate-Kalfópulos²,

Romero-Vargas³

et al. 2015

SPI

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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.

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The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion

Cited by 46 publications

References 27 publications

Depressive symptoms are associated with poor outcome for lumbar spine surgery

Depressive symptoms are associated with poor outcome for lumbar spine surgery

Which patients do not recover from shoulder impingement syndrome, either with operative treatment or with nonoperative treatment?

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

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