title: Physical and psychological comorbidity independently associated with spine-related disability.
abstract: METHODS
  Cross sectional analysis of patient-reported spine-related disability and comorbidity.
  
  
  OBJECTIVE
  To determine if nonorthopedic physical and psychological comorbidity are independently associated with self-reported spine-related disability in patients scheduled for spine surgery.
  
  
  BACKGROUND
  The association between psychological comorbidity and spine-related disability is well known; less is known about the contribution of nonorthopedic physical comorbidity to patients' ratings of spine-related disability.
  
  
  METHODS
  Several days before surgery, 175 patients with cervical problems and 538 patients with lumbar problems completed the Neck Disability Index and the Oswestry Disability Index, respectively; scores range from 0% to 100%; higher scores reflect more disability. The Charlson Comorbidity Index, a standard index of weighted major physical comorbidity, was used to dichotomize patients according to no major physical comorbidity (Charlson Comorbidity Index=0) or any major physical comorbidity (Charlson Comorbidity Index≥1). Psychological comorbidity was measured for depressive symptoms and anxiety with validated scales.
  
  
  RESULTS
  Mean age of patients with cervical problems was 54 years, 60% were males, mean Neck Disability Index score was 44%, and 25% had major physical comorbidity. In multivariate analysis controlling for younger age (P<0.0001) and female sex (P<0.0001), more depressive symptoms (P=0.0003), and having major physical comorbidity (P=0.02) were associated with worse Neck Disability Index scores. Mean age of patients with lumbar problems was 56 years, 55% were males, mean Oswestry Disability Index score was 56%, and 30% had major physical comorbidity. In multivariate analysis controlling for younger age (P=0.36) and female sex (P=0.002), more depressive symptoms (P<0.0001), and having major physical comorbidity (P=0.03) were associated with worse Oswestry Disability Index scores.
  
  
  CONCLUSIONS
  Psychological comorbidity and nonorthopedic physical comorbidity measured by a standard index are associated with patient-reported spine-related disability in patients undergoing cervical and lumbar spine surgery. Given that disability is a major indicator for surgery, how psychological and physical comorbidity influence patients' assessment of spine-related disability merits further investigation.
  
  
  METHODS
  2.
authors.affiliation: From the Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Mancuso
authors.forename: Marina
authors.initials: M
authors.lastname: Stal
authors.forename: Roland
authors.initials: R
authors.lastname: Duculan
authors.forename: Federico P
authors.initials: FP
authors.lastname: Girardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013122:Spinal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult