Mayo Benjamin C, Massel Dustin H, Bohl Daniel D, Long William W, Modi Krishna D, Narain Ankur S, Hijji Fady Y, Lopez Gregory, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center Chicago, IL.
Clin Spine Surg. 2017 Dec;30(10):E1388-E1391. doi: 10.1097/BSD.0000000000000466.
This is a retrospective cohort study.
To determine if preoperative mental health is associated with patient-reported outcomes (PROs) following a minimally invasive lumbar discectomy.
PROs are commonly used to quantify a patient's perceived health status. Recently, mental health has been theorized to directly affect patients' perception of their disability and pain after spine surgery.
A registry of patients who underwent a primary, single-level minimally invasive lumbar discectomy was reviewed. The association between preoperative Short-Form Health Survey mental composite score (MCS) and change in PROs [Oswestry Disability Index, back and leg visual analog scale (VAS) pain scores] from preoperative to postoperative (6-week, 12-week, 6-month) timepoints was assessed using multivariate regression controlling for patient demographics and the respective preoperative PRO. Patients in the top and bottom quartiles of preoperative MCS were compared regarding achievement of minimum clinically important difference for each PRO.
A total of 110 patients were included in the analysis. Better preoperative mental health was associated with lower preoperative disability and decreased preoperative back VAS (P<0.05 for each). Higher preoperative MCS was also associated with greater improvements in back VAS at 6-weeks postoperatively (P<0.05). There was no association between preoperative MCS and change in any PROs at the 12-week or 6-month postoperative visits. Patients in the bottom quartile of preoperative MCS achieved minimum clinically important difference in all PROs at similar rates to patients in the top quartile of preoperative MCS.
Patients with better preoperative mental health scores are more likely to report decreased disability and pain preoperatively. However, preoperative mental health was not predictive of changes in long-term disability or pain. As a result, patients with a wide range of preoperative mental health scores can achieve satisfactory long-term reductions in disability and pain levels after a lumbar discectomy.
Level IV.
这是一项回顾性队列研究。
确定术前心理健康状况与微创腰椎间盘切除术后患者报告结局（PROs）之间是否存在关联。
PROs常用于量化患者感知的健康状况。最近，有理论认为心理健康会直接影响患者对脊柱手术后残疾和疼痛的感知。
回顾了接受初次单节段微创腰椎间盘切除术患者的登记资料。使用多变量回归分析，控制患者人口统计学特征和各自的术前PRO，评估术前简短健康调查心理综合评分（MCS）与术前至术后（6周、12周、6个月）各时间点PROs变化[Oswestry功能障碍指数、背部和腿部视觉模拟量表（VAS）疼痛评分]之间的关联。比较术前MCS处于上四分位数和下四分位数的患者在各PRO上达到最小临床重要差异的情况。
共有110例患者纳入分析。术前心理健康状况较好与术前残疾程度较低及术前背部VAS评分降低相关（每项P<0.05）。术前MCS较高还与术后6周背部VAS评分改善更大相关（P<0.05）。术前MCS与术后12周或6个月时任何PROs的变化均无关联。术前MCS处于下四分位数的患者在所有PROs上达到最小临床重要差异的比例与术前MCS处于上四分位数的患者相似。
术前心理健康评分较好的患者术前残疾和疼痛程度更可能较低。然而，术前心理健康状况并不能预测长期残疾或疼痛的变化。因此，术前心理健康评分范围广泛的患者在腰椎间盘切除术后可实现残疾和疼痛水平令人满意的长期降低。
四级。
