Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
Spine (Phila Pa 1976). 2022 Sep 15;47(18):1287-1294. doi: 10.1097/BRS.0000000000004371. Epub 2022 Jul 14.
A retrospective cohort study.
To determine if depression and/or anxiety significantly affect patient-reported outcome measures (PROMs) after posterior cervical decompression and fusion (PCDF).
Mental health diagnoses are receiving increased recognition for their influence of outcomes after spine surgery. The magnitude that mental health disorders contribute to patient-reported outcomes following PCDF requires increased awareness and understanding.
A review of electronic medical records identified patients who underwent a PCDF at a single institution during the years 2013-2020. Patients were placed into either depression/anxiety or nondepression/anxiety group based on their medical history. A delta score (∆) was calculated for all PROMs by subtracting postoperative from preoperative scores. χ 2 tests and t tests were utilized to analyze categorical and continuous data, respectively. Regression analysis determined independent predictors of change in PROMs. Alpha was set at 0.05.
A total of 195 patients met inclusion criteria, with 60 (30.8%) having a prior diagnosis of depression/anxiety. The depression/anxiety group was younger (58.8 vs . 63.0, P =0.012), predominantly female (53.3% vs . 31.9%, P =0.007), and more frequently required revision surgery (11.7% vs . 0.74%, P =0.001). In addition, they had worse baseline mental component (MCS-12) (42.2 vs . 48.6, P <0.001), postoperative MCS-12 (46.5 vs . 52.9, P =0.002), postoperative neck disability index (NDI) (40.7 vs . 28.5, P =0.001), ∆NDI (-1.80 vs . -8.93, P =0.010), NDI minimum clinically important difference improvement (15.0% vs . 29.6%, P =0.046), and postoperative Visual Analog Scale (VAS) Neck scores (3.63 vs . 2.48, P =0.018). Only the nondepression/anxiety group improved in MCS-12 ( P =0.002) and NDI ( P <0.001) postoperatively. Depression and/or anxiety was an independent predictor of decreased magnitude of NDI improvement on regression analysis (β=7.14, P =0.038).
Patients with history of depression or anxiety demonstrate less improvement in patient-reported outcomes and a higher revision rate after posterior cervical fusion, highlighting the importance of mental health on clinical outcomes after spine surgery.
回顾性队列研究。
确定抑郁和/或焦虑是否显著影响颈椎后路减压融合术（PCDF）后的患者报告结局测量（PROM）。
精神健康诊断因其对脊柱手术后结果的影响而受到越来越多的关注。精神健康障碍对 PCDF 后患者报告结果的影响程度需要提高认识和理解。
对一家医疗机构 2013 年至 2020 年期间接受 PCDF 的电子病历进行了回顾。根据病史将患者分为抑郁/焦虑组或非抑郁/焦虑组。通过从术前得分中减去术后得分，计算所有 PROM 的差值得分（∆）。 χ 2 检验和 t 检验分别用于分析分类数据和连续数据。回归分析确定了 PROM 变化的独立预测因素。α 值设定为 0.05。
共有 195 名患者符合纳入标准，其中 60 名（30.8%）有抑郁/焦虑的既往诊断。抑郁/焦虑组更年轻（58.8 岁 vs. 63.0 岁，P =0.012），主要为女性（53.3% vs. 31.9%，P =0.007），更常需要翻修手术（11.7% vs. 0.74%，P =0.001）。此外，他们的基线心理健康成分（MCS-12）较差（42.2 分 vs. 48.6 分，P <0.001），术后 MCS-12 更差（46.5 分 vs. 52.9 分，P =0.002），术后颈部残疾指数（NDI）更差（40.7 分 vs. 28.5 分，P =0.001），NDI 差值较小（-1.80 分 vs. -8.93 分，P =0.010），NDI 最小临床重要差异改善程度较低（15.0% vs. 29.6%，P =0.046），术后视觉模拟量表（VAS）颈部评分较高（3.63 分 vs. 2.48 分，P =0.018）。只有非抑郁/焦虑组在 MCS-12（P =0.002）和 NDI（P <0.001）方面术后有改善。抑郁和/或焦虑是 NDI 改善程度降低的独立预测因素（β=7.14，P =0.038）。
有抑郁或焦虑病史的患者在颈椎后路融合术后 PROM 改善程度较小，翻修率较高，这突出了心理健康对脊柱手术后临床结果的重要性。
