Lynch Conor P, Cha Elliot D K, Patel Madhav R, Jacob Kevin C, Mohan Shruthi, Geoghegan Cara E, Jadczak Caroline N, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
Int J Spine Surg. 2022 Dec;16(6):1046-1053. doi: 10.14444/8333. Epub 2022 Jul 14.
Individual items within the Patient Health Questionnaire-9 (PHQ-9) have not been assessed as predictors of postoperative outcomes. Our objective is to study the relationship between responses to individual PHQ-9 items and achievement of a minimum clinically important difference (MCID) following anterior cervical discectomy and fusion (ACDF).
A prospective surgical database was reviewed for primary, single-level ACDF procedures performed for degenerative spinal pathology. Patient demographics, preoperative spinal pathology, and perioperative characteristics were recorded. Patient-reported outcome measures (PROMs) including PHQ-9, visual analog scale (VAS) neck and arm, Neck Disability Index, 12-item Short Form physical component score (SF-12 PCS), and Patient-Reported Outcomes Measurement Information System Physical Function were administered at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. MCID achievement was determined by comparing postoperative PROM improvement from baseline to previously established values. Logistic regression assessed responses to each individual question of the preoperative PHQ-9 as predictors of MCID achievement in each other PROMs.
Sixty-six ACDF patients were included with a mean age of 47.2 years. Herniated nucleus pulposus was the most common preoperative spinal diagnosis (95.6%). The mean operative duration was 50.3 minutes, the mean estimated blood loss was 27.5 mL, and most patients were discharged on postoperative day 0 (81.8%). A majority of patients achieved MCID for all measures except SF-12 PCS. PHQ-9 question 3 significantly predicted MCID achievement for VAS neck ( = 0.045), VAS arm ( = 0.049), and SF-12 PCS ( = 0.037). No other PHQ-9 items or overall PHQ-9 scores significantly predicted MCID achievement.
Question 3 of the PHQ-9 regarding "trouble falling asleep, staying asleep, or sleeping too much" significantly predicted clinically meaningful improvement in neck pain, arm pain, and physical function following ACDF, although overall PHQ-9 scores did not. Providers should inform patients experiencing significant sleep-related difficulties that they may be especially likely to benefit from ACDF surgery.
Evaluation of sleep from the PHQ-9 predicts clinically relevant improvement in neck pain, arm pain, and physical function in patients undergoing ACDF.
患者健康问卷-9（PHQ-9）中的单个条目尚未被评估为术后结果的预测指标。我们的目的是研究PHQ-9单个条目的回答与颈椎前路椎间盘切除融合术（ACDF）后达到最小临床重要差异（MCID）之间的关系。
回顾一个前瞻性手术数据库，纳入因退行性脊柱病变接受的一期单节段ACDF手术。记录患者的人口统计学资料、术前脊柱病变情况及围手术期特征。在术前以及术后6周、12周、6个月、1年和2年的时间点，采用患者报告结局指标（PROMs），包括PHQ-9、视觉模拟量表（VAS）颈部和手臂评分、颈部功能障碍指数、12项简明健康调查量表身体成分评分（SF-12 PCS）以及患者报告结局测量信息系统身体功能量表。通过比较术后PROMs较基线水平的改善情况与先前确定的值来确定是否达到MCID。采用逻辑回归分析术前PHQ-9每个问题的回答作为其他PROMs中MCID达成情况的预测指标。
纳入66例ACDF患者，平均年龄47.2岁。术前最常见的脊柱诊断为椎间盘突出症（95.6%）。平均手术时间为50.3分钟，平均估计失血量为27.5毫升，大多数患者在术后第0天出院（81.8%）。除SF-12 PCS外，大多数患者在所有测量指标上均达到了MCID。PHQ-9问题3显著预测了VAS颈部评分（P = 0.045）、VAS手臂评分（P = 0.049）和SF-12 PCS评分（P = 0.037）达到MCID的情况。其他PHQ-9条目或PHQ-9总分均未显著预测MCID的达成情况。
PHQ-9中关于“入睡困难、睡眠维持困难或睡眠过多”的问题3显著预测了ACDF术后颈部疼痛、手臂疼痛和身体功能的临床有意义改善，尽管PHQ-9总分未显示出这种预测作用。医疗服务提供者应告知有明显睡眠相关困难的患者，他们可能特别有可能从ACDF手术中获益。
通过PHQ-9评估睡眠情况可预测ACDF患者颈部疼痛、手臂疼痛和身体功能的临床相关改善。
