Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland.
Spine (Phila Pa 1976). 2011 Apr 15;36(8):677-82. doi: 10.1097/BRS.0b013e3181dcaf4a.
Prospective clinical study.
To investigate the effect of depressive symptoms on the surgery outcome on 2-year follow-up among lumbar spinal stenosis (LSS) patients.
Previous research has suggested an association between preoperative depressive symptoms and a poorer surgery outcome among LSS patients. There have been no previous studies on the effect of depressive symptoms on the surgery outcome at the 2-year postoperative phase.
A total of 96 patients (mean age, 62 years) with symptomatic LSS underwent decompressive surgery. They completed the same set of questionnaires before surgery and 3 months, 6 months, 1 year, and 2 years after surgery. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability, he visual analogue scale, and pain drawing. Comparisons were made according to depression status. Logistic regression analysis was used to examine the factors associated with a poorer surgery outcome on 2-year follow-up.
After surgery, the patients with continuous depression showed poorer improvement in symptom severity, the disability score, and walking capacity than the patients who did not have depression in any phase. In those patients who recovered from depression, the postoperative improvement resembled that of the constant normal mood group. In regression analyses, an independent association was detected between high preoperative BDI scores and 2-year disability and symptom severity. Strong independent associations were seen between depression burden (the sum of preoperative, 3-month and 6-month BDI scores) and 2-year disability, symptom severity, and poor walking capacity.
The patients with a normal mood and those who recovered from depressive symptoms enjoyed the most favorable outcome. Depressive symptoms interfere strongly with the ability of patients to obtain an optimal surgery outcome. Treatment models including the assessment and treatment of depression are encouraged.
前瞻性临床研究。
探讨抑郁症状对腰椎管狭窄症（LSS）患者术后 2 年随访手术效果的影响。
既往研究表明，术前抑郁症状与 LSS 患者手术效果较差有关。既往研究尚未探讨抑郁症状对术后 2 年手术效果的影响。
96 例（平均年龄 62 岁）有症状的 LSS 患者接受减压手术。他们在术前、术后 3 个月、6 个月、1 年和 2 年完成了相同的问卷。采用贝克抑郁量表（BDI）评估抑郁。采用 Oswestry 残疾指数、Stucki 问卷、自我报告的步行能力、视觉模拟量表和疼痛图评估躯体功能和疼痛。根据抑郁状态进行比较。采用逻辑回归分析探讨与术后 2 年手术效果较差相关的因素。
手术后，持续性抑郁患者的症状严重程度、残疾评分和步行能力改善较无任何阶段抑郁的患者差。在抑郁恢复的患者中，术后改善类似于持续正常情绪组。在回归分析中，术前 BDI 评分高与术后 2 年残疾和症状严重程度独立相关。抑郁负担（术前、术后 3 个月和 6 个月 BDI 评分之和）与术后 2 年残疾、症状严重程度和行走能力差有很强的独立关联。
情绪正常的患者和抑郁症状恢复的患者获得了最佳的治疗效果。抑郁症状严重影响患者获得最佳手术效果的能力。鼓励采用包括评估和治疗抑郁在内的治疗模式。
