Sidney Kimmel Medical College at Thomas Jefferson University.
Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
Clin Spine Surg. 2020 Dec;33(10):E472-E477. doi: 10.1097/BSD.0000000000000957.
Retrospective comparative study.
The goal was to determine whether comorbid depression and/or anxiety influence outcomes after anterior cervical discectomy and fusion (ACDF) for patients with degenerative cervical pathology.
The role preoperative mental health has on patient reported outcomes after ACDF surgery is not well understood.
Patients undergoing elective ACDF for degenerative cervical pathology were identified. Patients were grouped based on their preoperative mental health comorbidities, including patients with no history, depression, anxiety, and those with both depression and anxiety. All preoperative medical treatment for depression and/or anxiety was identified. Outcomes including Physical Component Score (PCS-12), Mental Component Score (MCS-12), Neck Disability Index (NDI), Visual Analogue Scale neck pain score (VAS Neck ), and Visual Analogue Scale arm pain score (VAS Arm) were compared between groups from baseline to postoperative measurements using multiple linear regression analysis-controlling for factors such as age, sex, and body mass index, etc. A P-value <0.05 was considered statistically significant.
A total of 264 patients were included in the analysis, with an average age of 53 years and mean follow-up of 19.8 months (19.0-20.6). All patients with a diagnosis of depression or anxiety also reported medical treatment for the disease. The group with no depression or anxiety had significantly less baseline disability than the group with 2 mental health diagnoses, in MCS-12 (P=0.009), NDI (P<0.004), VAS Neck (P=0.003), and VAS Arm (P=0.001) scores. Linear regression analysis demonstrated that increasing occurrence of mental health disorders was not a significant predictor of change over time for any of the outcome measures included in the analysis.
Despite more severe preoperative symptoms, patients with a preoperative mental health disorder(s) demonstrated significant improvement in postoperative outcomes after ACDF. No differences were identified in postoperative outcomes between each of the groups.
Level III.
回顾性对比研究。
旨在确定患有退行性颈椎疾病的患者在前路颈椎间盘切除融合术（ACDF）后，合并抑郁和/或焦虑是否会影响结果。
术前心理健康对 ACDF 手术后患者报告的结果的影响尚不清楚。
确定了接受择期 ACDF 治疗退行性颈椎疾病的患者。根据患者术前的心理健康合并症进行分组，包括无病史、抑郁、焦虑和同时患有抑郁和焦虑的患者。确定所有抑郁和/或焦虑的术前治疗。通过多元线性回归分析比较基线至术后测量的物理成分评分（PCS-12）、心理成分评分（MCS-12）、颈部残疾指数（NDI）、颈部视觉模拟评分（VAS Neck）和手臂视觉模拟评分（VAS Arm），控制年龄、性别和体重指数等因素。P 值<0.05 被认为具有统计学意义。
共纳入 264 例患者进行分析，平均年龄为 53 岁，平均随访时间为 19.8 个月（19.0-20.6）。所有诊断为抑郁或焦虑的患者也报告了对该病的药物治疗。无抑郁或焦虑症的患者在 MCS-12（P=0.009）、NDI（P<0.004）、VAS Neck（P=0.003）和 VAS Arm（P=0.001）评分上的基线残疾程度明显低于有 2 种精神健康诊断的患者。线性回归分析表明，精神健康障碍的发生率增加不是分析中包括的任何结果测量指标随时间变化的显著预测因素。
尽管术前症状更严重，但患有术前精神健康障碍的患者在前路颈椎间盘切除融合术后的术后结果有明显改善。每组患者之间在术后结果方面没有差异。
III 级。
