title: Influence of depression on patients satisfaction with the outcome of microsurgical "key-hole" vs classical discectomy: prospective matched-cohort study.
abstract: OBJECTIVE
  To assess the influence of depression on patients' satisfaction with lumbar discectomy performed by two different surgical techniques.
  
  
  METHODS
  A prospective matched-cohort analysis of classical lumbar discectomy following static imaging (n = 45) and microlumbar "key-hole" discectomy after dynamic CT/myelography (n = 55) was performed. The outcome was independently assessed using Prolo economic/activity (E) and functional/pain (F) scale, and depressiveness according to Hamilton rating scale. Patients without improvement on the Prolo scale were classified as failed back surgery syndrome, and with a Hamilton score 17 as depressive.
  
  
  RESULTS
  The groups were well matched by age, sex, clinical presentation and incidence of depression. In the "key-hole" group, both activity and pain outcome were better than in the classical technique group (median E score (range) = 4 (2-5) vs 3 (2-4), p = 0.002, median F score (range) = 4 (2-5) vs 4 (1-5), p = 0.008). Eighteen patients were classified as failed back syndrome, 6 in the "key-hole" group, and 12 in the classical group (z = 3.16, p = 0.075). The incidence of failed back syndrome among non-depressive patients was significantly lower in "key-hole" group (2/55 patients vs 8/45, z = 2.345, p = 0.009). Occurrence of unsatisfactory results among depressive patients was very similar in both groups (4/55 patients vs 4/45, z = 0.296, p = 0.384).
  
  
  CONCLUSIONS
  Introduction of functional imaging and "key-hole" technique decreased incidence of failed back syndrome among non-depressive patients. Unsatisfactory outcome among depressive patients was unrelated to the imaging and surgical technique. Connection between depression and failed back syndrome, although detected, remains unclear and must be further investigated.
authors.affiliation: Division of Neurosurgery, General Hospital-Marinespital MDCCCLXI, Pula, Croatia. marin.stancic@pu.tel.hr
authors.forename: Ivana
authors.initials: I
authors.lastname: Ljubicić Bistrović
authors.forename: Dulijano
authors.initials: D
authors.lastname: Ljubicić
authors.forename: Darko
authors.initials: D
authors.lastname: Ekl
authors.forename: Ljubomir
authors.initials: L
authors.lastname: Penezić
authors.forename: Dejvis
authors.initials: D
authors.lastname: Mocenić
authors.forename: Marin F
authors.initials: MF
authors.lastname: Stancić
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017523:Croatia; D003863:Depression / Q000150:complications / Q000523:psychology*; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000523:psychology / Q000601:surgery*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D016896:Treatment Outcome