title: The impact of preoperative depression on quality of life outcomes after posterior cervical fusion.
abstract: BACKGROUND
  Posterior cervical fusion (PCF) has been shown to be an effective treatment for cervical spondylosis, but is associated with a 9% complication rate and high costs. To limit such complications and costs, it is imperative that proper selection of surgical candidates occur for those most likely to do well with the surgery. Affective disorders, such as depression, are associated with worsened outcomes after lumbar surgery; however, this effect has not been evaluated in patients undergoing cervical spine surgery.
  
  
  OBJECTIVE
  To assess the predictive value of preoperative depression and the health state on 1-year quality of life (QOL) outcomes after PCF.
  
  
  METHODS
  A retrospective cohort analysis.
  
  
  METHODS
  Eighty-eight patients who underwent PCF for cervical spondylosis were reviewed.
  
  
  METHODS
  Preoperative and 1-year postoperative health outcomes were assessed based on the Pain Disability Questionnaire (PDQ), the Patient Health Questionnaire-9 (PHQ-9), and the EuroQol five-dimensions (EQ-5D) questionnaire.
  
  
  METHODS
  Univariable and multivariable regression analyses were performed to assess for preoperative predictors of 1-year change in health status.
  
  
  RESULTS
  Compared with preoperative health states, the PCF cohort showed statistically significant improved PDQ (87.8 vs. 73.6), PHQ-9 (7.7 vs. 6.6), and EQ-5D (0.50 vs. 0.60) scores at 1 year postoperatively. Only 10/88 (11%) patients achieved or surpassed the minimum clinically important difference for the PHQ-9 (5). Multiple linear and logistic regression analyses showed that increasing PHQ-9 and EQ-5D preoperative scores were associated with reduced 1-year postoperative improvement in health status (EQ-5D index).
  
  
  CONCLUSIONS
  Of patients who undergo PCF, those with a greater degree of preoperative depression have lower improvements in postoperative QOL compared with those with less depression. Additionally, patients with better preoperative health states also attain lower 1-year QOL improvements.
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Alvin
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Miller
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA.
authors.forename: Swetha
authors.initials: S
authors.lastname: Sundar
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH 44106, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Lockwood
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lubelski
authors.affiliation: Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nowacki
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Neurological Center for Pain, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Scheman
authors.affiliation: Neurological Center for Pain, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Manu
authors.initials: M
authors.lastname: Mathews
authors.affiliation: Carolina Neurosurgery & Spine Associates, 225 Baldwin Ave, Charlotte, NC 28204, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.affiliation: Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA; Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave., Cleveland, OH 44195, USA; Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA. Electronic address: mrozt@ccf.org.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mroz
mesh_terms: D000368:Aged; D003863:Depression / Q000150:complications / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods / Q000523:psychology*; D055009:Spondylosis / Q000150:complications / Q000523:psychology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: CSM; Cervical fusion; Depression; Myelopathy; Outcomes; PCF; PHQ-9