title: Observational Study of Depression in Patients Undergoing Cervical Disc Arthroplasty: Evidence of a Correlation between Pain Relief and Resolution of Depression.
abstract: BACKGROUND
  Depression has been associated with inferior outcomes following lumbar spine surgery. Our purpose was to investigate the prevalence of depression and its impact on the outcomes of a large sample of cervical disc arthroplasty patients and to examine the change in depression occurring in conjunction with changes in disability and pain.
  
  
  METHODS
  A cohort of 271 patients who underwent single or multi-level cervical disc arthroplasty at a single orthopedic center filled out the Neck Disability Index, Medical Outcomes Study SF-36, numerical rating scales for neck pain and arm pain, preoperatively and 12-month postoperatively. Patients were classified as Depressed or Non-Depressed, based on their preoperative SF-36 Mental Component Summary (MCS) score. Preoperative scores, 12-month postoperative scores, and change in scores (adjusted for preoperative scores, smoking status, and strenuous job) were compared between Depressed and Non-Depressed. Next, patients in the 2 groups were subdivided into 4 groups: Always Depressed, Never Depressed, No Longer Depressed, and Newly Depressed, based on their combined preoperative and postoperative MCS scores. The same score comparisons were conducted among the 4 groups.
  
  
  RESULTS
  Forty-four percent (118 of 271) of the patients in our sample were Depressed. Despite a significant improvement after surgery, Depressed patients had poorer pre- and postoperative scores than Non-Depressed patients for NDI, MCS, neck pain and arm pain. Two-thirds (80 of 118) of the Depressed patients were No Longer Depressed at 12 months and had postoperative scores similar to the Never Depressed patients. Eight percent (12 of 153) of the Non-Depressed patients became Newly Depressed by 12 months and had postoperative scores similar to the Always Depressed patients.
  
  
  CONCLUSIONS
  Depression is a common occurrence in patients with cervical disorders. Relief from pain and disability after cervical disc arthroplasty can be associated with relief from depression, but poor outcomes may also result in patients becoming depressed.
authors.affiliation: The Orthopedic Center of St. Louis, St Louis, MO.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Gornet
authors.affiliation: SPIRITT Research, St. Louis, MO.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Copay
authors.affiliation: SPIRITT Research, St. Louis, MO.
authors.forename: Francine W
authors.initials: FW
authors.lastname: Schranck
authors.affiliation: Department of Health Services, University of Washington, Seattle, WA.
authors.forename: Branko
authors.initials: B
authors.lastname: Kopjar
keywords: Cervical disc arthroplasty; Depression; Spine surgery; cervical spine pathology; patient-reported outcomes; quality of life