Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States.
Georgetown University School of Medicine, 3900 Reservoir Road, NW Med-Dent, A-114 Washington, DC 20007, United States.
J Clin Neurosci. 2024 Sep;127:110759. doi: 10.1016/j.jocn.2024.110759. Epub 2024 Jul 24.
Patients with lumbar spinal pathology often suffer from anxiety and sleep disturbance, but correlations between anxiety and sleep disturbance and other patient-reported outcome measures (PROMs) before and after surgical intervention have not been explored. The purpose of this study is to analyze the correlations between patient-reported anxiety, sleep disturbance, and PROMs before and after lumbar decompression.
All patients undergoing elective, primary, lumbar decompression were retrospectively queried from a prospectively-maintained single spine surgeon database. Demographic and perioperative data and pre- and postoperative PROMs were extracted. Patient-Reported Outcome Measure Information System (PROMIS)-Anxiety, PROMIS-Sleep Disturbance (SD), PROMIS-Physical Function (PF), 9-Item Patient Health Questionnaire (PHQ-9), Visual Analog Scale (VAS)-Back, VAS-Leg, Oswestry Disability Index (ODI) were obtained preoperatively and through two years postoperatively. Pearson's correlation coefficients were calculated between PROMIS-Anxiety, PROMIS-SD, and the other PROMs of interest.
PROMIS-Anxiety was positively correlated with PROMIS-SD (range: r = 0.473-0.828, p ≤ 0.006, all), PHQ-9 (range: r = 0.613--0.890, p ≤ 0.006, all), VAS-Back (range: r = -0.410-0.798, p ≤ 0.039, all), and ODI (range: r = 0.503-0.732, p ≤ 0.033, all) at all timepoints. PROMIS-Anxiety was negatively correlated with PROMIS-PF through 1 year postoperatively (range: r = -0.323- -0.729p ≤ 0.033, all). PROMIS-Anxiety was positively correlated to VAS-Leg at preoperative, 6-week, 12-week, and 2-year postoperative timepoints (range: r = 0.333--0.707, p ≤ 0.022, all). PROMIS-SD was positively correlated with PHQ-9 (range: r = 0.600-0.836), VASBack (range: r = 0.383-0.734), VAS-Leg (range: r = 0.399-0.811), and ODI (range: r = 0.404-0.812) at all timepoints (p ≤ 0.031, all). PROMIS-SD was negatively correlated with PROMIS-PF at all timepoints (range: r = -0.339-0.665, p ≤ 0.035, all).
Patient-reported anxiety and sleep disturbance are significantly correlated with depressive burden, back pain, disability, and physical function, before and after lumbar decompression. Future studies should aim to determine the directionality of the associations and test interventions to improve health-related quality of life following lumbar decompression.
腰椎病变患者常伴有焦虑和睡眠障碍，但手术干预前后焦虑和睡眠障碍与其他患者报告的结局测量（PROMs）之间的相关性尚未得到探讨。本研究的目的是分析腰椎减压前后患者报告的焦虑、睡眠障碍和 PROMs 之间的相关性。
我们从一位脊柱外科医生前瞻性维护的数据库中回顾性查询了所有接受择期、原发性腰椎减压的患者。提取人口统计学和围手术期数据以及术前和术后的 PROMs。获得了患者报告的结果测量信息系统（PROMIS）-焦虑、PROMIS-睡眠障碍（SD）、PROMIS-身体功能（PF）、9 项患者健康问卷（PHQ-9）、视觉模拟量表（VAS）-背部、VAS-腿部、Oswestry 残疾指数（ODI），分别在术前和术后两年进行评估。计算了 PROMIS-焦虑、PROMIS-SD 与其他感兴趣的 PROMs 之间的 Pearson 相关系数。
PROMIS-焦虑与 PROMIS-SD（范围：r=0.473-0.828，p≤0.006，全部）、PHQ-9（范围：r=0.613-0.890，p≤0.006，全部）、VAS-背部（范围：r=-0.410-0.798，p≤0.039，全部）和 ODI（范围：r=0.503-0.732，p≤0.033，全部）在所有时间点均呈正相关。PROMIS-焦虑与术后 1 年的 PROMIS-PF 呈负相关（范围：r=-0.323--0.729，p≤0.033，全部）。PROMIS-焦虑与术前、6 周、12 周和术后 2 年的 VAS-腿部呈正相关（范围：r=0.333--0.707，p≤0.022，全部）。PROMIS-SD 与 PHQ-9（范围：r=0.600-0.836）、VAS 背部（范围：r=0.383-0.734）、VAS 腿部（范围：r=0.399-0.811）和 ODI（范围：r=0.404-0.812）在所有时间点均呈正相关（p≤0.031，全部）。PROMIS-SD 与所有时间点的 PROMIS-PF 呈负相关（范围：r=-0.339-0.665，p≤0.035，全部）。
腰椎减压前后，患者报告的焦虑和睡眠障碍与抑郁负担、腰背疼痛、残疾和身体功能显著相关。未来的研究应旨在确定相关性的方向，并测试改善腰椎减压后健康相关生活质量的干预措施。
