A study published in The Spine Journal examines how preoperative depression impacts the quality of life for patients undergoing posterior cervical fusion.
The study examined 88 patients who underwent posterior cervical fusion for cervical spondylolisthesis and tracked for one year postoperatively. The researchers found:
1. After undergoing posterior cervical fusion, patients showed statistically significant Pain Disability Questionnaire, Patient Health Questionnaire and EuroQol-5 Dimensions Questionnaire score improvement when compared with the preoperative health state. At one year after surgery, the average scores were:
• PDQ: 87.8 (vs. 73.6)
• PHQ-9: 7.7 (vs. 6.6)
• EQ-5D: 0.50 (vs. 0.60)
2. However, only 11 percent of the patients achieved or surpassed the minimum clinically important difference for the Patient Health Questionnaire. Studies have shown patients with depression and other affective disorders are associated with worse outcomes after lumbar spine surgery, but the same had not been evaluated for cervical spine surgery.
In a study about how depression impacts lumbar spine surgery patients, authors concluded "preoperative depression is a factor that needs to be recognized. Depression measured with the BDI, predicted postoperative disability and pain among surgically treated LSS patients."
3. Increased Patient Health Questionnaire and EuroQol-5 Dimensions Questionnaire postoperative scores were associated with reduced one-year postoperative improvement in the health status, according to multiple linear and logistic regression analyses conducted by the study authors.
However, a survey of orthopedic surgeons and neurosurgeons found less than half screened patients for depression and anxiety preoperatively, according to dailyRX. Physicians were more likely to screen patients if the patient had a psychological disorder and more experienced surgeons — surgeons with more than 15 years of practice — were more likely to refer than less experienced physicians. Finally, surgeons in private practice were more likely to assess patients for depression and anxiety than university-affiliated surgeons.
4. The posterior cervical spine surgery study authors concluded "those with a greater degree of preoperative depression have lower improvement in postoperative [quality of life] compared to those with less decompression." The authors of the lumbar spine surgery study found patients who recovered from depression had similar outcomes to the improvement in the "normal mood" group, leading the authors to recommend a depression assessment for patients.
5. Posterior cervical fusion is considered an effective treatment for cervical spondylosis, according to the study, but is associated with 9 percent complication rate and high costs. However, proper patient selection could limit complication risk and lower costs.
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