Javeed Saad, Yakdan Salim, Benedict Braeden, Saleem Samia, Kaleem Muhammad, Zhang Justin K, Frumkin Madelyn R, Hardi Angela, Neuman Brian, Kelly Michael P, Goodin Burel R, Rodebaugh Thomas L, Ray Wilson Z, Greenberg Jacob K
Department of Neurological Surgery, Washington University, St. Louis, MO, USA.
Department of Musculoskeletal Research, Washington University, St. Louis, MO, USA.
Global Spine J. 2025 Jan 24:21925682251316245. doi: 10.1177/21925682251316245.
Systematic review and Meta-analysis.
To quantify the association of preoperative depression on patient reported outcome measures (PROMS) after cervical spine surgery.
We systematically searched PubMed, Cochrane, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov until September 14, 2023. Studies including adults undergoing cervical spine surgery and comparing PROMs between depressed and non-depressed patients were included. The primary outcome was the postoperative in disability, pain, and physical function. Secondary outcomes included absolute disease severity before and after surgery. We conducted random-effects meta-analysis.
After screening 3813 articles, 20 studies were included, encompassing 3964 patients (mean age 57, 51% males) with median follow-up duration of 12 months. There was significant heterogeneity in estimates of the primary outcome ( = 81%). While patients with depression had a greater magnitude of improvement compared with patients without depression, it was not statistically significant (SMD = 0.04, [95% CI: -0.07, 0.16], = 80%; = 0.48). However, patients with depression exhibited worse disease severity preoperatively (SMD = -0.31, [-0.44, -0.19], = 84%; < 0.001) and postoperatively (SMD = -0.31, [-0.48, -0.15], = 89%; < 0.002). Sensitivity analyses with meta-regression found that older age, sex (male-to-female ratio), percentage of comorbidities, study quality, follow-up duration, number of adjusted factors in the analysis, and surgical approach were significant sources of heterogeneity.
Patients with depression experienced similar improvements in disability, pain, and physical function after cervical surgery compared to patients without depression. However, patients with depression exhibited worse disease severity before and after surgery.
系统评价和荟萃分析。
量化颈椎手术后术前抑郁与患者报告结局指标（PROMS）之间的关联。
我们系统检索了PubMed、Cochrane、Embase、Scopus、PsychInfo、Web of Science和ClinicalTrials.gov，检索截至2023年9月14日的文献。纳入的研究包括接受颈椎手术的成年人，并比较了抑郁患者和非抑郁患者的PROMS。主要结局是术后残疾、疼痛和身体功能。次要结局包括手术前后的绝对疾病严重程度。我们进行了随机效应荟萃分析。
在筛选了3813篇文章后，纳入了20项研究，涵盖3964例患者（平均年龄57岁，51%为男性），中位随访时间为12个月。主要结局的估计存在显著异质性（I² = 81%）。虽然与无抑郁患者相比，抑郁患者的改善幅度更大，但差异无统计学意义（标准化均数差[SMD]=0.04，[95%置信区间：-0.07，0.16]，I² = 80%；P = 0.48）。然而，抑郁患者术前疾病严重程度更差（SMD = -0.31，[-0.44，-0.19]，I² = 84%；P < 0.001），术后也是如此（SMD = -0.31，[-0.48，-0.15]，I² = 89%；P < 0.002）。采用Meta回归的敏感性分析发现，年龄、性别（男女比例）、合并症百分比、研究质量、随访时间、分析中的调整因素数量和手术方式是异质性的重要来源。
与无抑郁患者相比，抑郁患者颈椎手术后在残疾、疼痛和身体功能方面的改善相似。然而，抑郁患者手术前后的疾病严重程度更差。
