title: Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis.
abstract: BACKGROUND
  Persistent back pain and leg pain after index surgery is distressing to patients and spinal surgeons. Revision surgical treatment is technically challenging and has been reported to yield unpredictable outcomes. Recently, affective disorders, such as depression and anxiety, have been considered potential predictors of surgical outcomes across many disease states of chronic pain. There remains a paucity of studies assessing the predictive value of baseline depression on outcomes in the setting of revision spine surgery.
  
  
  OBJECTIVE
  To assess the predictive value of preoperative depression on 2-year postoperative outcome after revision lumbar surgery for symptomatic pseudarthrosis, adjacent segment disease (ASD), and same-level recurrent stenosis.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  One hundred fifty patients undergoing revision surgery for symptomatic ASD, pseudarthrosis, and same-level recurrent stenosis.
  
  
  METHODS
  Patient-reported outcome measures were assessed using an outcomes questionnaire that included questions on health-state values (EQ-5D), disability (Oswestry Disability Index [ODI]), pain (visual analog scale), depression (Zung Self-Rating Depression Scale), and 12-Item Short Form Health Survey physical and mental component scores.
  
  
  METHODS
  One hundred fifty patients undergoing revision neural decompression and instrumented fusion for ASD (n=50), pseudarthrosis (n=47), or same-level recurrent stenosis (n=53) were included in this study. Preoperative Zung Self-Reported Depression Scale score was assessed for all patients. Preoperative and 2-year postoperative visual analog scale for back pain and leg pain scores and ODI were assessed. The association between preoperative Zung Depression Scale score and 2-year improvement in disability was assessed via multivariate regression analysis.
  
  
  RESULTS
  Compared to preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (8.72±1.85 vs. 3.92±2.84, p=.001), pseudoarthrosis (7.31±0.81 vs. 5.06±2.64, p=.001), and same-level recurrent stenosis (9.28±1.00 vs. 5.00±2.94, p=.001). Two-year ODI was also significantly improved after surgery for ASD (28.72±9.64 vs. 18.48±11.31, p=.001), pseudoarthrosis (29.74±5.35 vs. 25.42±6.00, p=.001), and same-level recurrent stenosis (36.01±6.00 vs. 21.75±12.07, p=.001). Independent of age, BMI, symptom duration, smoking, comorbidities, and level of preoperative pain and disability, increasing preoperative Zung depression score was significantly associated with less 2-year improvement in disability (ODI) after revision surgery for ASD, pseudoarthrosis, and recurrent stenosis.
  
  
  CONCLUSIONS
  Our study suggests that the extent of preoperative depression is an independent predictor of functional outcome after revision lumbar surgery for ASD, pseudoarthrosis, and recurrent stenosis. Future comparative effectiveness studies assessing outcomes after revision lumbar surgery should account for depression as a potential confounder. The Zung depression questionnaire may help risk stratify patients presenting for revision lumbar surgery.
authors.affiliation: Department of Neurosurgery, The Spinal Column Surgical Quality and Outcomes Research Laboratory, Vanderbilt University Medical Center, 4347 Village at Vanderbilt, Nashville, TN 37232-8618, USA.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: David N
authors.initials: DN
authors.lastname: Shau
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Mendenhall
authors.forename: Oran S
authors.initials: OS
authors.lastname: Aaronson
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D019299:Decompression, Surgical / Q000523:psychology; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010147:Pain Measurement; D057234:Preoperative Period; D011542:Pseudarthrosis / Q000150:complications / Q000601:surgery*; D020127:Recovery of Function; D013123:Spinal Fusion / Q000523:psychology*; D013130:Spinal Stenosis / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome