Colantonio Donald F, Nassr Ahmad, Freedman Brett A, Elder Benjamin D, Bydon Mohamad, Helgeson Melvin D, Kepler Christopher K, Sebastian Arjun S, Wagner Scott C
Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Int J Spine Surg. 2022 Apr;16(2):233-239. doi: 10.14444/8211.
The effect of preoperative mental health on outcomes after anterior cervical discectomy and fusion (ACDF) is of increasing interest. The purpose of this study was to utilize patient-reported outcome measures (PROMs) to compare outcomes after ACDF in patients with and without poor mental health. We hypothesized that patients with worse baseline mental health would report worse outcomes after surgery.
Patients undergoing ACDF for degenerative cervical spondylosis with at least 12 months of follow-up were included. Outcomes collected before and after surgery included the RAND-36, Neck Disability Index (NDI), EuroQol 5-dimension (EQ-5D), and Single Assessment Numeric Evaluation (SANE) score.
Seventy-one patients were included and assigned to the depression or nondepression group based on baseline mental health. The depression group had worse baseline preoperative scores across all PROMs: NDI (44.2 vs 36.8, = 0.05), RAND (1511.4 vs 2198.18, < 0.001), EQ-5D (12.55 vs 10.14, < 0.001), and SANE (56.3 vs 72.9, < 0.001). Postoperatively, the depression group had worse scores at the final follow-up for RAND (2242.8 vs 2662.2, = 0.03) and SANE (71.5 vs 80.8, = 0.02). Both groups experienced improvements with ACDF across all PROMs. The changes in each PROM were not statistically significant between groups. There were no statistically significant differences in the percentage of patients achieving the minimal clinically important difference across PROMs.
This study is the first to utilize the RAND-36, EQ-5D, NDI, and SANE scores to assess preoperative mental health and its effect on postoperative outcomes after ACDF. While poor preoperative mental health status yielded significantly worse baseline and postoperative outcomes scores, patients experienced significant improvement in symptoms after ACDF.
Clinicians should be aware of the effects of poor mental health status on clinical outcomes in patients undergoing anterior cervical fusion, but can still expect significant clinical improvements after surgery.
术前心理健康对颈椎前路椎间盘切除融合术（ACDF）术后疗效的影响日益受到关注。本研究的目的是利用患者报告结局量表（PROMs）比较心理健康状况良好和不佳的患者ACDF术后的疗效。我们假设基线心理健康状况较差的患者术后报告的疗效较差。
纳入因退行性颈椎病接受ACDF且随访至少12个月的患者。手术前后收集的结局指标包括兰德36项健康调查简表（RAND-36）、颈部功能障碍指数（NDI）、欧洲五维健康量表（EQ-5D）和单项评估数字评定法（SANE）评分。
共纳入71例患者，并根据基线心理健康状况分为抑郁组和非抑郁组。抑郁组在所有PROMs中的术前基线评分均较差：NDI（44.2对36.8，P = 0.05）、RAND（1511.4对2198.18，P < 0.001）、EQ-5D（12.55对10.14，P < 0.001）和SANE（56.3对72.9，P < 0.001）。术后，抑郁组在末次随访时RAND（2242.8对2662.2，P = 0.03）和SANE（71.5对80.8，P = 0.02）评分较差。两组患者ACDF术后所有PROMs均有改善。各PROMs组间变化无统计学意义。在达到各PROMs最小临床重要差异的患者百分比方面，两组无统计学显著差异。
本研究首次利用RAND-36、EQ-5D、NDI和SANE评分评估术前心理健康及其对ACDF术后结局的影响。虽然术前心理健康状况较差导致基线和术后结局评分明显更差，但患者ACDF术后症状有显著改善。
临床医生应意识到心理健康状况不佳对颈椎前路融合术患者临床结局的影响，但术后仍可预期有显著的临床改善。
