Depression is associated with a poorer outcome of lumbar spinal stenosis surgery: a two-year prospective follow-up study.

STUDY DESIGN

Prospective clinical study.

OBJECTIVE

To investigate the effect of depressive symptoms on the surgery outcome on 2-year follow-up among lumbar spinal stenosis (LSS) patients.

SUMMARY OF BACKGROUND DATA

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.