Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Spine (Phila Pa 1976). 2021 Oct 15;46(20):1378-1386. doi: 10.1097/BRS.0000000000004029.
Retrospective cohort.
To assess the relationship of depressive symptoms with patient reported outcome measures (PROMs) in patients undergoing either primary or revision anterior cervical discectomy and fusion (ACDF) procedures.
Depression has been associated with poorer outcomes following ACDF. However, research examining the relationship between depression and PROMs in revision ACDF procedures is limited.
A prospective database was retrospectively reviewed for primary or revision, single- or multilevel ACDF procedures from 2016 to 2019. Patients lacking preoperative Patient Health Questionnaire-9 (PHQ-9) surveys were excluded. Demographic and perioperative characteristics were recorded and analyzed using Fisher's exact test or t test. Patient-reported outcome measures were collected preoperatively and postoperatively. Postoperative improvement from baseline scores (ΔPROM) was calculated at all postoperative timepoints. Differences in mean PROM and ΔPROM between groups and changes from baseline PROM scores within groups were assessed using Student's t test. Linear regression analyzed the impact of preoperative PHQ-9 on ΔPROM.
A total of 143 patients (121 primary and 22 revision) were included. Significant differences between groups were demonstrated at the preoperative timepoint for Neck Disability Index (NDI) (P = 0.022). ΔPROM values did not significantly differ between groups. Regression analysis revealed significant relationships between preoperative PHQ-9 and ΔPHQ-9 at all timepoints, ΔVAS neck at 6-weeks and 6-months, ΔVAS arm at 6-months, and ΔNDI at 6-weeks and 6-months for the primary group (all P < 0.05). Regression analysis revealed no significant associations for the revision group.
Primary or revision ACDF procedures did not significantly differ in depressive symptoms through 1-year. Primary ACDF patients significantly improved in all PROMs through all timepoints, while revision patients had limited improvement in PROMs. Preoperative depression may have a stronger association on postoperative outcomes for primary procedures.Level of Evidence: 3.
回顾性队列研究。
评估抑郁症状与接受初次或翻修前路颈椎间盘切除融合术（ACDF）的患者的患者报告结局测量（PROM）之间的关系。
抑郁与 ACDF 后的不良结果相关。然而，关于翻修 ACDF 手术中抑郁与 PROM 之间关系的研究有限。
从 2016 年至 2019 年，对初次或翻修、单节段或多节段 ACDF 手术的前瞻性数据库进行了回顾性分析。排除了术前缺乏患者健康问卷-9（PHQ-9）调查的患者。记录并使用 Fisher 确切检验或 t 检验分析人口统计学和围手术期特征。收集术前和术后患者报告的结果测量值。在所有术后时间点计算从基线评分的术后改善（ΔPROM）。使用学生 t 检验评估组间平均 PROM 和ΔPROM 以及组内从基线 PROM 评分的变化。线性回归分析了术前 PHQ-9 对ΔPROM 的影响。
共纳入 143 例患者（121 例初次和 22 例翻修）。在术前时间点，颈痛障碍指数（NDI）（P=0.022）两组间存在显著差异。两组间ΔPROM 值无显著差异。回归分析显示，在所有时间点，术前 PHQ-9 与ΔPHQ-9、初次组术后 6 周和 6 个月的ΔVAS 颈痛、术后 6 个月的ΔVAS 手臂、术后 6 周和 6 个月的ΔNDI 之间存在显著关系（均 P<0.05）。回归分析显示，对于翻修组，没有显著的相关性。
初次或翻修 ACDF 手术在 1 年内抑郁症状无显著差异。初次 ACDF 患者在所有 PROM 中均显著改善，而翻修患者在 PROM 方面改善有限。术前抑郁可能与初次手术的术后结果有更强的关联。
3。
