van Grafhorst Judith, van Furth Wouter, Vleggeert-Lankamp Carmen
University Neurosurgical Center Holland, LUMC | HMC | HAGA, the Netherlands.
Department of Neurosurgery, Spaarne Gasthuis, Haarlem, Hoofddorp, the Netherlands.
Brain Spine. 2024 Sep 7;4:103902. doi: 10.1016/j.bas.2024.103902. eCollection 2024.
Mental status, characterised by anxiety and depression, significantly influences physical well-being, particularly in patients with spinal stenosis symptoms.
The prevalence of depression and anxiety in our cohort. The correlation between psychological distress and physical outcome after surgery, including postoperative recovery and satisfaction.
Questionnaires evaluating anxiety and depression (HADS), functionality (ODI), quality of life (EQ-5D), and perceived recovery (Likert-scale) were sent to a randomly selected cohort of 450 lumbar spinal stenosis patients, with or without spondylolisthesis, who underwent surgery between 2007 and 2013. Results are presented, dichotomised by HADS score (score ≥8 indicating psychologically impaired) and in a Four Quadrants Model integrating functional outcomes and perceived recovery separately for psychologically impaired and non-impaired cases.
Among the 147 included patients, 32 (22%) exhibited anxiety and/or depression (impaired cases). Satisfactory outcome (perceived recovery) was reported in 29.0% of the impaired cases and 78.3% of the non-impaired cases (p < 0.001). The mean postoperative functionality score of the impaired cases was 42.46 ± 16.24, in contrast to 18.48 ± 18.25 for the non-impaired cases (p < 0.001). In the impaired group, only 12.5% achieved both a good functional outcome (ODI ≤24) and satisfactory perceived recovery, compared with 58.4% in the non-impaired group.
Patients reporting anxiety and/or depression demonstrate an inferior long-term outcome after spinal stenosis surgery compared to non-impaired patients. This clinically relevant difference underscores the importance of addressing depression and anxiety in preoperative counselling to optimize patient satisfaction and functional outcomes.
以焦虑和抑郁为特征的心理状态对身体健康有显著影响，在有椎管狭窄症状的患者中尤为如此。
我们队列中抑郁和焦虑的患病率。心理困扰与手术后身体结果之间的相关性，包括术后恢复和满意度。
向2007年至2013年间接受手术的450例腰椎管狭窄症患者（无论有无椎体滑脱）的随机选择队列发放评估焦虑和抑郁（医院焦虑抑郁量表）、功能（腰椎功能障碍指数）、生活质量（欧洲五维度健康量表）和感知恢复（李克特量表）的问卷。结果按医院焦虑抑郁量表评分（评分≥8表明心理受损）进行二分法呈现，并采用四象限模型分别针对心理受损和未受损病例整合功能结果和感知恢复情况。
在纳入的147例患者中，32例（22%）表现出焦虑和/或抑郁（受损病例）。受损病例中有29.0%报告结果满意（感知恢复），未受损病例中有78.3%报告结果满意（p<0.001）。受损病例的术后平均功能评分为42.46±16.24，未受损病例为18.48±18.25（p<0.001）。在受损组中，只有12.5%的患者在功能结果良好（腰椎功能障碍指数≤24）的同时感知恢复满意，而未受损组这一比例为58.4%。
与未受损患者相比，报告有焦虑和/或抑郁的患者在椎管狭窄手术后的长期结果较差。这种临床相关差异强调了在术前咨询中解决抑郁和焦虑问题以优化患者满意度和功能结果的重要性。
