Abstract
Background context
Persistent back pain and leg pain after index surgery is distressing to patients and
spinal surgeons. Revision surgical treatment is technically challenging and has been
reported to yield unpredictable outcomes. Recently, affective disorders, such as depression
and anxiety, have been considered potential predictors of surgical outcomes across
many disease states of chronic pain. There remains a paucity of studies assessing
the predictive value of baseline depression on outcomes in the setting of revision
spine surgery.
Purpose
To assess the predictive value of preoperative depression on 2-year postoperative
outcome after revision lumbar surgery for symptomatic pseudarthrosis, adjacent segment
disease (ASD), and same-level recurrent stenosis.
Study design
Retrospective cohort study.
Patient sample
One hundred fifty patients undergoing revision surgery for symptomatic ASD, pseudarthrosis,
and same-level recurrent stenosis.
Outcome measures
Patient-reported outcome measures were assessed using an outcomes questionnaire that
included questions on health-state values (EQ-5D), disability (Oswestry Disability
Index [ODI]), pain (visual analog scale), depression (Zung Self-Rating Depression
Scale), and 12-Item Short Form Health Survey physical and mental component scores.
Methods
One hundred fifty patients undergoing revision neural decompression and instrumented
fusion for ASD (n=50), pseudarthrosis (n=47), or same-level recurrent stenosis (n=53)
were included in this study. Preoperative Zung Self-Reported Depression Scale score
was assessed for all patients. Preoperative and 2-year postoperative visual analog
scale for back pain and leg pain scores and ODI were assessed. The association between
preoperative Zung Depression Scale score and 2-year improvement in disability was
assessed via multivariate regression analysis.
Results
Compared to preoperative status, VAS-BP was significantly improved 2 years after surgery
for ASD (8.72±1.85 vs. 3.92±2.84, p=.001), pseudoarthrosis (7.31±0.81 vs. 5.06±2.64,
p=.001), and same-level recurrent stenosis (9.28±1.00 vs. 5.00±2.94, p=.001). Two-year
ODI was also significantly improved after surgery for ASD (28.72±9.64 vs. 18.48±11.31,
p=.001), pseudoarthrosis (29.74±5.35 vs. 25.42±6.00, p=.001), and same-level recurrent
stenosis (36.01±6.00 vs. 21.75±12.07, p=.001). Independent of age, BMI, symptom duration,
smoking, comorbidities, and level of preoperative pain and disability, increasing
preoperative Zung depression score was significantly associated with less 2-year improvement
in disability (ODI) after revision surgery for ASD, pseudoarthrosis, and recurrent
stenosis.
Conclusions
Our study suggests that the extent of preoperative depression is an independent predictor
of functional outcome after revision lumbar surgery for ASD, pseudoarthrosis, and
recurrent stenosis. Future comparative effectiveness studies assessing outcomes after
revision lumbar surgery should account for depression as a potential confounder. The
Zung depression questionnaire may help risk stratify patients presenting for revision
lumbar surgery.
Keywords
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Article info
Publication history
Published online: September 22, 2011
Accepted:
August 4,
2011
Received in revised form:
May 17,
2011
Received:
February 16,
2011
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: OA: Nothing to disclose. SLP: Nothing to disclose. DNS: Nothing to disclose. SKM: Nothing to disclose. OSA: Nothing to disclose. JSC: Speaking/Teaching Arrangements: Synthes (B). CJD: Research Support (Staff/Materials): DePuy (C, Paid directly to institution/employer). MJM: Research Support (Staff/Materials): Globus (E), DePuy (E).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
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Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Commentary: Revision lumbar surgery and revisiting the role of preoperative depression screeningThe Spine JournalVol. 12Issue 3
