Preoperative mental health status may not be predictive of improvements in patient-reported outcomes following an anterior cervical discectomy and fusion.
OBJECTIVE Prior studies have correlated preoperative depression and poor mental health status with inferior patient-reported outcomes following lumbar spinal procedures. However, literature regarding the effect of mental health on outcomes following cervical spinal surgery is limited. As such, the purpose of this study is to test for the association of preoperative SF-12 Mental Component Summary (MCS) scores with improvements in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), and neck and arm pain following anterior cervical discectomy and fusion (ACDF). METHODS A prospectively maintained surgical database of patients who underwent a primary 1- or 2-level ACDF during 2014-2015 was reviewed. Patients were excluded if they did not have complete patient-reported outcome data for the preoperative or 6-week, 12-week, or 6-month postoperative visits. At baseline, preoperative SF-12 MCS score was assessed for association with preoperative NDI, neck visual analog scale (VAS) score, arm VAS score, and SF-12 PCS score. The preoperative MCS score was then tested for association with changes in NDI, neck VAS, arm VAS, and SF-12 PCS scores from the preoperative visit to postoperative visits. These tests were conducted using multivariate regression controlling for baseline characteristics as well as for the preoperative score for the patient-reported outcome being assessed. RESULTS A total of 52 patients were included in the analysis. At baseline, a higher preoperative MCS score was negatively associated with a lower preoperative NDI (coefficient: -0.74, p < 0.001) and preoperative arm VAS score (-0.06, p = 0.026), but not preoperative neck VAS score (-0.03, p = 0.325) or SF-12 PCS score (0.04, p = 0.664). Additionally, there was no association between preoperative MCS score and improvement in NDI, neck VAS, arm VAS, or SF-12 PCS score at any of the postoperative time points (6 weeks, 12 weeks, and 6 months, p > 0.05 for each). The percentage of patients achieving a minimum clinically important difference at 6 months did not differ between the bottom and top MCS score halves (p > 0.05 for each). CONCLUSIONS The results of this study suggest that better preoperative mental health status is associated with lower perceived preoperative disability but is not associated with severity of preoperative neck or arm pain. In contrast to other studies, the present study was unable to demonstrate that preoperative mental health is predictive of improvement in patient-reported outcomes at any postoperative time point following an ACDF.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Benjamin C
BC
Mayo
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Dustin H
DH
Massel
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Daniel D
DD
Bohl
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Ankur S
AS
Narain
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Fady Y
FY
Hijji
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
William W
WW
Long
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Krishna D
KD
Modi
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Bryce A
BA
Basques
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Alem
A
Yacob
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Kern
K
Singh
D002574:Cervical Vertebrae / Q000601:surgery*; D016208:Databases, Factual; D004185:Disability Evaluation; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000523:psychology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000523:psychology; D000071066:Patient Reported Outcome Measures; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome
ACDF; ACDF = anterior cervical discectomy and fusion; CCI = Charlson Comorbidity Index; MCID = minimum clinically important difference; MCS = Mental Component Summary; NDI; NDI = Neck Disability Index; PCS = Physical Component Summary; PRO = patient-reported outcome; SF-12; VAS; VAS = visual analog scale; anterior cervical discectomy and fusion; depression; mental health; neck disability index; outcomes; visual analog scale