Mayo Benjamin C, Narain Ankur S, Hijji Fady Y, Massel Dustin H, Bohl Daniel D, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Int J Spine Surg. 2020 Feb 29;14(1):26-31. doi: 10.14444/7003. eCollection 2020 Feb.
Prior literature has associated poor preoperative mental health with inferior patient-reported outcomes (PROs) after spinal procedures. Therefore, the objective of this study was to test for association of preoperative Short Form 12 (SF-12) mental health composite score (MCS) with improvements in Oswestry Disability Index (ODI) and back and leg visual analogue scale (VAS) pain scores after a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
A surgical database of patients who underwent a primary, 1 level MIS TLIF was reviewed. Preoperative SF-12 MCS was tested for association with preoperative ODI, back VAS, and leg VAS. Preoperative MCS was then tested for association with changes in ODI, back VAS, and leg VAS from preoperative to postoperative visits. These tests were conducted using multivariate regression controlling for baseline characteristics and the preoperative score of the PRO being assessed.
A total of 113 patients were included in the analysis. At baseline, higher preoperative MCS was associated with lower preoperative ODI (coefficient: -0.58, < .001), lower preoperative back VAS (-0.05, = .003), and lower preoperative leg VAS (-0.06, = .003). However, there was no association between preoperative MCS and improvement in PROs at any postoperative timepoint ( > .05). The percent of patients achieving a minimum clinically important difference in PROs at 6 months did not differ between the bottom and top MCS halves ( > .05).
The results of this study suggest that better preoperative mental health is associated with lower perceived preoperative disability and decreased severity of back and leg pain. In contrast to other studies, the present study was unable to demonstrate that preoperative mental health is predictive of improvement in PROs at any postoperative timepoint after MIS TLIF.
These results suggest that surgeons should exercise care in assuming that patients with poorer preoperative mental health are inferior surgical candidates.
既往文献表明，脊柱手术后患者报告的结局（PROs）较差与术前心理健康状况不佳有关。因此，本研究的目的是检验术前简明健康状况调查量表12项（SF - 12）心理健康综合评分（MCS）与微创经椎间孔腰椎椎间融合术（MIS TLIF）后Oswestry功能障碍指数（ODI）以及腰背部和腿部视觉模拟量表（VAS）疼痛评分改善之间的相关性。
回顾接受初次单节段MIS TLIF手术患者的手术数据库。检验术前SF - 12 MCS与术前ODI、腰背部VAS和腿部VAS之间的相关性。然后检验术前MCS与术前至术后访视期间ODI、腰背部VAS和腿部VAS变化之间的相关性。这些检验采用多变量回归进行，控制基线特征以及所评估PRO的术前评分。
共有113例患者纳入分析。在基线时，术前较高的MCS与较低的术前ODI（系数： - 0.58，P < 0.001）、较低的术前腰背部VAS（ - 0.05，P = 0.003）和较低的术前腿部VAS（ - 0.06，P = 0.003）相关。然而，术前MCS与术后任何时间点PROs的改善之间均无相关性（P > 0.05）。MCS下半部分和上半部分患者在6个月时达到PROs最小临床重要差异的百分比无差异（P > 0.05）。
本研究结果表明，较好的术前心理健康状况与较低的术前感知功能障碍以及腰背部和腿部疼痛严重程度降低相关。与其他研究不同，本研究未能证明术前心理健康状况可预测MIS TLIF术后任何时间点PROs的改善情况。
3级。
这些结果表明，外科医生在认为术前心理健康状况较差的患者是较差的手术候选者时应谨慎。
