Cunningham Erin E, Bigney Erin, Dombrowski Stephan U, Wedderkopp Niels, Manson Neil, Attabib Najmeddan, Abraham Edward, Small Chris, Richardson Eden, Yang Michael M H, Crawford Eric, Weber Michael H, Paquet Jerome, Christie Sean D, Charest-Morin Raphaele, LaRue Bernard, Nataraj Andrew, Hall Hamilton, Rampersaud Y Raja, Fisher Charles, Dea Nicolas, Bailey Chris, Hébert Jeffrey J
Faculty of Nursing, University of New Brunswick, Fredericton, Canada.
Faculty of Kinesiology, University of New Brunswick, Fredericton, NB, Canada.
Sci Rep. 2025 Apr 28;15(1):14861. doi: 10.1038/s41598-025-97575-2.
This study aimed to estimate the effects of preoperative psychological health on postoperative outcomes in patients undergoing surgery for cervical spondylotic radiculopathy. This retrospective cohort study included data from patients enrolled in the Canadian Spine Outcomes and Research Network who underwent anterior cervical discectomy and fusion for radiculopathy. Preoperative psychological health was measured with the Patient Health Questionnaire-8 (PHQ-8), and depression and severe psychological symptomology were measured with the Mental Component Score of the Short Form Survey-12 (MCS). Surgical outcomes comprised trajectory subgroups for neck pain and arm pain (numeric rating scales) and disability (neck disability index) measured preoperatively and 3, 12, and 24 months after surgery. For each outcome, patients were dichotomized as following either a poor or a fair-to-excellent trajectory. Average treatment effects were estimated with doubly robust propensity score models using inverse probability of treatment weights accounting for multiple confounders. We included data from 352 patients (43.8% female). Approximately half (52.1%) of patients were identified as depressed based on the PHQ-8, while 61.8% and 33.1% were classified as experiencing depression or severe psychological symptomology, respectively, on the MCS. In fully adjusted models, patients with PHQ-8-measured depression were at increased risk of poor postoperative outcomes for disability (risk ratio[95% CI] = 6.73[1.85 to 24.45]) and neck pain (RR[95% CI] = 1.90[1.09 to 3.32]). Patients with MCS-measured depression were at elevated risk of a poor disability outcome (RR[95% CI] = 2.77[1.30 to 5.90]). Patients reporting severe psychological symptomatology had an increased likelihood of poor disability, neck pain, and arm pain outcomes (RR[95% CI] = 1.82 [1.17 to 2.82] to 2.84[1.58 to 5.09]). These findings highlight the high prevalence of negative psychological features and their impacts on neck surgery outcomes. Future research should prioritize the development and evaluation of preoperative interventions to optimize psychological well-being and improve surgical outcomes in this population.
本研究旨在评估术前心理健康状况对神经根型颈椎病手术患者术后结局的影响。这项回顾性队列研究纳入了加拿大脊柱结局与研究网络中因神经根型病变接受颈椎前路椎间盘切除融合术的患者数据。术前心理健康状况采用患者健康问卷-8（PHQ-8）进行评估，抑郁和严重心理症状采用简短形式调查-12（MCS）的心理成分评分进行评估。手术结局包括术前以及术后3个月、12个月和24个月测量的颈部疼痛和手臂疼痛（数字评分量表）及残疾（颈部残疾指数）的轨迹亚组。对于每个结局，患者被分为预后差或预后良好至优秀的轨迹。使用考虑多个混杂因素的治疗权重逆概率的双重稳健倾向评分模型估计平均治疗效果。我们纳入了352例患者的数据（43.8%为女性）。根据PHQ-8，约一半（52.1%）的患者被确定为抑郁，而根据MCS，分别有61.8%和33.1%的患者被归类为患有抑郁或严重心理症状。在完全调整模型中，PHQ-8测量的抑郁患者术后残疾（风险比[95%CI] = 6.73[1.85至24.45]）和颈部疼痛（RR[95%CI] = 1.90[1.09至3.32]）预后差的风险增加。MCS测量的抑郁患者残疾预后差的风险升高（RR[95%CI] = 2.77[1.30至5.90]）。报告有严重心理症状的患者残疾、颈部疼痛和手臂疼痛预后差的可能性增加（RR[95%CI] = 1.82 [1.17至2.82]至2.84[1.58至5.09]）。这些发现凸显了负面心理特征的高患病率及其对颈部手术结局的影响。未来的研究应优先开展和评估术前干预措施，以优化该人群的心理健康状况并改善手术结局。
