The Relationship Between Preoperative General Mental Health and Postoperative Quality of Life in Minimally Invasive Lumbar Spine Surgery

Asher, Rachel; Mason, Ashley E.; Weiner, Joseph A.; Fessler, Richard G.

doi:10.1227/neu.0000000000000695

Cited by 17 publications

(5 citation statements)

References 33 publications

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“…[15][16][17][18][19][20] For instance, Adogwa et al 21 demonstrated in their prospective study of patients with a known diagnosis of depression or anxiety undergoing ACDF that pretreatment of their mental condition resulted in significantly better postoperative outcomes in terms of pain and disability. Contrastingly, Asher et al 22 found no relationship between preoperative general mental health as measured by the SF-36 MCS and postoperative patient-reported outcomes following minimally invasive lumbar spine surgery. Sundseth et al 23 demonstrated a correlation between physical function assessed by the legacy outcome measure Neck Disability Index and the SF-36 MCS in patients scheduled to undergo surgery for cervical radiculopathy.…”

Section: Discussionmentioning

confidence: 93%

Evaluation of Postoperative Mental Health Outcomes in Patients Based on Patient-Reported Outcome Measurement Information System Physical Function Following Anterior Cervical Discectomy and Fusion

et al. 2020

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Objective: To assess the relationship of preoperative physical function, as measured by Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF), to improvement in mental health, as evaluated by Short Form-12 Mental Component Summary (SF-12 MCS) following anterior cervical discectomy and fusion (ACDF). Methods: Patients undergoing primary ACDF were retrospectively reviewed and stratified based on preoperative PROMIS PF scores. PROMIS PF cohorts were tested for an association with demographic characteristics and perioperative variables using chi-square analysis and multivariate linear regression. Multivariate linear regression was utilized to determine the association between PROMIS PF cohorts and improvement in SF-12 MCS. Results: A total of 129 one-to 3-level ACDF patients were included: 73 had PROMIS PF < 40 ("low PROMIS") and 56 had PROMIS PF ≥ 40 ("high PROMIS"). The low PROMIS cohort reported worse mental health preoperatively and at all postoperative timepoints except for 1 year. Both cohorts had similar changes in mental health from baseline through the 6-month follow-up. However, at 1 year. postoperatively, the low PROMIS cohort had a statistically greater change in mental health score. Conclusion: Patients with worse preoperative physical function reported significantly worse preoperative and postoperative mental health. However, patients with worse preoperative physical function made significantly greater improvements in mental health from baseline. This suggests that patients with worse preoperative physical function can still expect significant improvements in mental health following surgery.

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Section: Discussionmentioning

confidence: 93%

Evaluation of Postoperative Mental Health Outcomes in Patients Based on Patient-Reported Outcome Measurement Information System Physical Function Following Anterior Cervical Discectomy and Fusion

et al. 2020

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“…Asher et al analyzed 83 patients undergoing minimally invasive lumbar surgery and found no relationship between preoperative general mental health and postoperative clinical outcomes (visual analog scale, ODI, or PCS) in patients with mental health scores comparable to the population mean. 1 The use of a prospective database with clinical data that were collected through a uniform process from 11 institutions is a major strength of this study, although the study is retrospective and nonrandomized. Groups were found to have similar demographics and coronal Cobb values, and thus confounding variables were limited.…”

Section: Discussionmentioning

confidence: 99%

“…8,10,23 Preoperative mental disease burden has been reported to have a significant impact on levels of pain intensity, disability, and HRQOL measures in patients undergoing spine surgery (Bakhsheshian et al, unpublished data, 2016). 1,9,10,13,23 Preoperative psychiatric conditions have been shown to be an independent risk factor for the development of adverse events during hospitalization after spine surgery. 15 However, other investigations have failed to demonstrate an association between self-reported psychological conditions and outcome scores following lumbar spine surgery.…”

mentioning

confidence: 99%

“…15 However, other investigations have failed to demonstrate an association between self-reported psychological conditions and outcome scores following lumbar spine surgery. 1,13 Of note, these studies did not have predefined comparative study groups, meaning that they did not classify patients with significant functional impairment as scoring at or below the 25th percentile for age-and sex-matched US population norms. 20 Further, the minimal clinically important differences (MCIDs) were not evaluated.…”

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confidence: 99%

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Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up

Bakhsheshian

Scheer

Gum

et al. 2017

SPI

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OBJECTIVE Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function. METHODS A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up. Patients were grouped by their 36-Item Short Form Health Survey mental component summary (MCS) and physical component summary (PCS) scores. Both groups had PCS scores ≤ 25th percentile for matched norms; however, the low mental health (LMH) group consisted of patients with an MCS score ≤ 25th percentile, and the high mental health (HMH) group included patients with an MCS score ≥ 75th percentile. RESULTS Of the 264 patients (72.3%) with a 2-year follow-up, 104 (28.5%) met the inclusion criteria for LMH and 40 patients (11.0%) met those for HMH. The LMH group had a significantly higher overall rate of comorbidities, specifically leg weakness, depression, hypertension, and self-reported neurological and psychiatric disease processes, and were more likely to be unemployed as compared with the HMH group (p < 0.05 for all). The 2 groups had similar 2-year postoperative improvements in HRQOL (p > 0.05) except for the greater improvements in the MCS and the Scoliosis Research Society-22r questionnaire (SRS-22r) mental domain (p < 0.05) in the LMH group and greater improvements in PCS and SRS-22r satisfaction and back pain domains (p < 0.05) in the HMH group. The LMH group had a higher rate of reaching a minimal clinically important difference (MCID) on the SRS-22r mental domain (p < 0.01), and the HMH group had a higher rate of reaching an MCID on the PCS and SRS-22r activity domain (p < 0.05). On multivariable logistic regression, having LMH was a significant independent predictor of failure to reach an MCID on the PCS (p < 0.05). At the 2-year postoperative follow-up, 14 LMH patients (15.1%) were categorized as HMH. Two LMH patients (2.2%), and 3 HMH patients (7.7%) transitioned to a PCS score ≥ 75th percentile for age- and sex-matched US norms (p < 0.01). CONCLUSIONS While patients with poor mental and physical health, according to their MCS and PCS scores, have higher medical comorbidity and unemployment rates, they still demonstrate significant improvements in HRQOL measurements postoperatively. Both LMH and HMH patient groups demonstrated similar improvements in most HRQOL domains, except that the LMH patients had difficulties in obtaining improvements in the PCS domain.

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“…Lower back pain affects almost one in ten people worldwide and is an important cause of disability (1,2). While surgery is currently the most effective therapy, despite treatment, many patients continue to endure chronic pain, sciatica, functional limitations, and a greatly diminished quality of life (3)(4)(5). Intervertebral disc degeneration (IDD) is a predominant cause of low back pain, which places an enormous burden on the individual and society (6,7).…”

Section: Introductionmentioning

confidence: 99%

Inhibition of miR-96-5p alleviates intervertebral disc degeneration by regulating the peroxisome proliferator-activated receptor γ/nuclear factor-kappaB pathway

Liu¹,

Hou²,

Yuan³

et al. 2023

Ann Transl Med

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Background: Intervertebral disc degeneration (IDD) is the main pathogenesis of low back pain.MicroRNAs (miRNAs) have been found to exert regulatory function in IDD. This study aimed to investigate the effect and potential mechanism of miR-96-5p in IDD. Methods: A vitro cell model of IDD was established by treating human nucleus pulposus cells (HNPCs) with interleukin-1β (IL-1β). The level of peroxisome proliferator-activated receptor γ (PPARγ) was examined in the IDD cell model by Western blot and quantification real-time reverse transcription-polymerase chain reaction (qRT-PCR). The expression level of miR-96-5p was detected by RT-qPCR. Effects of PPARγ or/ and PPARγ agonist on inflammatory factors, extracellular matrix (ECM), apoptosis, and nuclear factor-kappaB (NF-κB) nuclear translocation were examined through enzyme-linked immunosorbent assay (ELISA), Western blot, flow cytometry assay, and immunofluorescence staining. The starBase database and dual luciferase reporter assay were used to predict and validate the targeting relationship between miR-96-5p and PPARγ, and rescue assay was performed to gain insight into the role of miR-96-5p on IDD through PPARγ/ NF-κB signaling.Results: PPARγ expression reduced with concentration and time under IL-1β stimulation, while miR-96-5p expression showed the reverse trend. Upregulation or/and activation of PPARγ inhibited IL-1β-induced an increase in inflammatory factor levels, apoptosis, degradation of the ECM, and the nuclear translocation of NF-κB. MiR-96-5p was highly expressed but PPARγ was lowly expressed in IDD, while knockdown of PPARγ partially reversed remission of IDD induced by miR-96-5p downregulation. MiR-96-5p promoted NF-κB entry into the nucleus but PPARγ inhibited this process.Conclusions: Inhibition of miR-96-5p suppressed IDD progression by regulating the PPARγ/NF-κB pathway. MiR-96-5p may be a promising target for IDD treatment clinically.

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The Relationship Between Preoperative General Mental Health and Postoperative Quality of Life in Minimally Invasive Lumbar Spine Surgery

Cited by 17 publications

References 33 publications

Evaluation of Postoperative Mental Health Outcomes in Patients Based on Patient-Reported Outcome Measurement Information System Physical Function Following Anterior Cervical Discectomy and Fusion

Evaluation of Postoperative Mental Health Outcomes in Patients Based on Patient-Reported Outcome Measurement Information System Physical Function Following Anterior Cervical Discectomy and Fusion

Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up

Inhibition of miR-96-5p alleviates intervertebral disc degeneration by regulating the peroxisome proliferator-activated receptor γ/nuclear factor-kappaB pathway

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