title: The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prevalence of depressive symptoms and disability pre-operatively, at 3 months and at 1 year after lumbar spine fusion surgery.
  
  
  METHODS
  Data was extracted from a dedicated lumbar spine fusion register, giving 232 patients (mean age 62 years, 158 females) who had undergone instrumented lumbar spine fusion. The frequency of depressive symptoms and disability was evaluated using the Depression Scale (DEPS) and Oswestry Disability Index (ODI).
  
  
  RESULTS
  Depressive symptoms were found in 34, 13, and 15 % of the patients pre-operatively, at 3 months and at 1 year after surgery, respectively. The mean DEPS score decreased from 16.2 to 8.6 (p < 0.001) in patients who had depressive symptoms pre-operatively, and from 6.1 to 3.8 (p < 0.001) in those patients without pre-operative depressive symptoms. The mean ODI values pre-operatively, at 3 months and at 1 year after surgery were 53, 30, and 23, respectively, in patients with pre-operative depressive symptoms and 41, 23, and 20 in those patients without pre-operative depressive symptoms. The differences between the groups were statistically significant at all time points (p < 0.001).
  
  
  CONCLUSIONS
  One-third of our patients with chronic back pain undergoing spinal fusion had depressive symptoms pre-operatively. The prevalence of depressive symptoms decreased after surgery. Although disability remained higher in those patients who had reported depressive symptoms pre-operatively, disability did decrease significantly in both groups post-operatively. Thus, there is no need to exclude depressive patients from operation, but screening measures and appropriate treatment practises throughout both pre-operative and post-operative periods are encouraged.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Tampere University Hospital, Tampere, Finland, marko.wahlman@fimnet.fi.
authors.forename: Marko
authors.initials: M
authors.lastname: Wahlman
authors.forename: Arja
authors.initials: A
authors.lastname: Häkkinen
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.forename: Ilkka
authors.initials: I
authors.lastname: Marttinen
authors.forename: Kimmo
authors.initials: K
authors.lastname: Vihtonen
authors.forename: Marko H
authors.initials: MH
authors.lastname: Neva
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000601:surgery*; D003863:Depression / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D006801:Humans; D016014:Linear Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D013123:Spinal Fusion / Q000523:psychology*