Affective disorders influence clinical outcomes after revision lumbar surgery in elderly patients with symptomatic adjacent-segment disease, recurrent stenosis, or pseudarthrosis: clinical article.
OBJECTIVE
Depression and persistent low-back pain (LBP) are common and disabling problems in elderly patients (> 65 years old). Affective disorders, such as depression and anxiety, are also common in elderly patients, with a prevalence ranging from 4% to 16%. Depressive symptoms are consistently associated with functional disability. To date, few studies have assessed the predictive value of baseline depression on outcomes in the setting of revision spine surgery in elderly patients. Therefore, in this study, the authors assessed the predictive value of preoperative depression on 2-year postoperative outcomes.


METHODS
A total of 69 patients undergoing revision neural decompression and instrumented fusion for adjacent-segment disease (ASD, n = 28), pseudarthrosis (n = 17), or same-level recurrent stenosis (n = 24) were included in this study. Preoperative Zung Self-Rating Depression Scale (ZDS) scores were assessed for all patients. Preoperative and 2-year postoperative visual analog scale (VAS) scores for back pain (VAS-BP) and leg pain (VAS-LP) and the Oswestry Disability Index (ODI) were also assessed. The association between preoperative ZDS score and 2-year improvement in disability was assessed via multivariate regression analysis.


RESULTS
Compared with preoperative status, 2-year postoperative VAS-BP was significantly improved after surgery for ASD (9 ± 2 vs. 4.01 ± 2.56, respectively; p = 0.001), as were pseudarthrosis (7.41 ± 1 vs. 5.0 ± 3.08, respectively; p = 0.02) and same-level recurrent stenosis (7 ± 2.00 vs. 5.00 ± 2.34, respectively; p = 0.003). Two-year ODI was also significantly improved after surgery for ASD (29 ± 9 vs. 23.10 ± 10.18, respectively; p = 0.001), as were pseudarthrosis (28.47 ± 5.85 vs. 24.41 ± 7.75, respectively; p = 0.001) and same-level recurrent stenosis (30.83 ± 5.28 vs. 26.29 ± 4.10, respectively; p = 0.003). Independent of other factors-age, body mass index, symptom duration, smoking, comorbidities, severity of preoperative pain, and disability-increasing preoperative ZDS score was significantly associated with lower 2-year improvement in disability (ODI) after revision surgery in elderly patients with symptomatic ASD, pseudarthrosis, or recurrent stenosis.


CONCLUSIONS
The extent of preoperative depression is an independent predictor of less functional improvement following revision lumbar surgery in elderly patients with symptomatic ASD, pseudarthrosis, or recurrent stenosis. Timely diagnosis and treatment of depression and somatic anxiety in this cohort of patients may contribute to improvement in postoperative functional status.
Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina; and.
Owoicho
O
Adogwa
Terence
T
Verla
Paul
P
Thompson
Anirudh
A
Penumaka
Katherine
K
Kudyba
Kwame
K
Johnson
Erin
E
Fulchiero
Timothy
T
Miller
Kimberly B
KB
Hoang
Joseph
J
Cheng
Carlos A
CA
Bagley
D000368:Aged; D019299:Decompression, Surgical; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000523:psychology*; D011542:Pseudarthrosis / Q000523:psychology* / Q000601:surgery*; D012086:Reoperation / Q000523:psychology; D012307:Risk Factors; D016103:Spinal Fractures / Q000523:psychology* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013130:Spinal Stenosis / Q000523:psychology* / Q000601:surgery*; D016896:Treatment Outcome
ASD = adjacent-segment disease; BMI = body mass index; EQ-5D = EuroQol Group–5 Dimension; ODI = Oswestry Disability Index; SF-12 = 12-Item Short-Form Health Survey; VAS = visual analog scale; VAS-BP = VAS for back pain; VAS-LP = VAS for leg pain; ZDS = Zung Self-Rating Depression Scale; affective disorder; depression; functional disability; lumbar; spine outcome