title: Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up.
abstract: OBJECTIVE Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function. METHODS A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up. Patients were grouped by their 36-Item Short Form Health Survey mental component summary (MCS) and physical component summary (PCS) scores. Both groups had PCS scores ≤ 25th percentile for matched norms; however, the low mental health (LMH) group consisted of patients with an MCS score ≤ 25th percentile, and the high mental health (HMH) group included patients with an MCS score ≥ 75th percentile. RESULTS Of the 264 patients (72.3%) with a 2-year follow-up, 104 (28.5%) met the inclusion criteria for LMH and 40 patients (11.0%) met those for HMH. The LMH group had a significantly higher overall rate of comorbidities, specifically leg weakness, depression, hypertension, and self-reported neurological and psychiatric disease processes, and were more likely to be unemployed as compared with the HMH group (p < 0.05 for all). The 2 groups had similar 2-year postoperative improvements in HRQOL (p > 0.05) except for the greater improvements in the MCS and the Scoliosis Research Society-22r questionnaire (SRS-22r) mental domain (p < 0.05) in the LMH group and greater improvements in PCS and SRS-22r satisfaction and back pain domains (p < 0.05) in the HMH group. The LMH group had a higher rate of reaching a minimal clinically important difference (MCID) on the SRS-22r mental domain (p < 0.01), and the HMH group had a higher rate of reaching an MCID on the PCS and SRS-22r activity domain (p < 0.05). On multivariable logistic regression, having LMH was a significant independent predictor of failure to reach an MCID on the PCS (p < 0.05). At the 2-year postoperative follow-up, 14 LMH patients (15.1%) were categorized as HMH. Two LMH patients (2.2%), and 3 HMH patients (7.7%) transitioned to a PCS score ≥ 75th percentile for age- and sex-matched US norms (p < 0.01). CONCLUSIONS While patients with poor mental and physical health, according to their MCS and PCS scores, have higher medical comorbidity and unemployment rates, they still demonstrate significant improvements in HRQOL measurements postoperatively. Both LMH and HMH patient groups demonstrated similar improvements in most HRQOL domains, except that the LMH patients had difficulties in obtaining improvements in the PCS domain.
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles.
authors.forename: Joshua
authors.initials: J
authors.lastname: Bakhsheshian
authors.affiliation: University of California, San Diego, School of Medicine.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.affiliation: Norton Leatherman Spine Center, Louisville, Kentucky.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Gum
authors.affiliation: Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Rocky Mountain Hospital for Children, Denver, Colorado.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Themistocles S
authors.initials: TS
authors.lastname: Protopsaltis
authors.affiliation: Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California.
authors.forename: Malla Kate
authors.initials: MK
authors.lastname: Keefe
authors.affiliation: Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon; and.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.affiliation: Scripps Health, La Jolla.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013121:Spinal Curvatures / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D013997:Time Factors
keywords: ASA = American Society of Anesthesiologists; ASD = adult spinal deformity; BMI = body mass index; DRAM = Distress and Risk Assessment Method; EBL = estimated blood loss; HMH = high mental health; HRQOL; HRQOL = health-related quality of life; LL = lumbar lordosis; LMH = low mental health; LOS = length of hospital stay; MCID = minimal clinically important difference; MCS = mental component summary; NRS = numeric rating scale; ODI = Oswestry Disability Index; PCS = physical component summary; PI = pelvic incidence; PT = pelvic tilt; SF-36 = 36-Item Short Form Health Survey; SRS-22r = Scoliosis Research Society-22r questionnaire; SVA = sagittal vertical axis; TK = thoracic kyphosis; adult spinal deformity; health-related quality of life; mental health; outcomes; sagittal alignment; sagittal vertical axis