Mental health improvements after elective spine surgery: a Canadian Spine Outcome Research Network (CSORN) study |
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| Institution: | 1. McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4L8;2. University of Calgary, Foothills Medical Centre, 1403 - 29th Street NW Calgary, AB, Canada T2N 2T9;3. University of Ottawa, 1053 Carling Ave, Ottawa, Ontario, Canada, K1Y 4E9;4. Dalhousie University, 555 Somerset St, Suite 200, Saint John, New Brunswick, Canada, E2K 4X2;5. Dalhousie University, Department of Surgery (Neurosurgery), Halifax, Nova Scotia, Canada, B3H 4R2;6. University of British Columbia, 6th floor, 818 West 10th Avenue, Vancouver, British Columbia, Canada, V5Z 1M9;7. University of Manitoba, AD401 – 820 Sherbrook Street, Winnipeg, Manitoba, Canada, R3A 1R9;8. Western University, 800 Commissioners Rd. E., E1-317London, Ontario, Canada, N6A 5W9;9. University of Toronto, 494851 Traverston Road, Markdale, Ontario, Canada, N0C 1H0;10. CHU de Québec-Université Laval, 1401 18e rue, Québec City, Quebec, Canada, G1J 1Z4;1. Department of Orthopedic Surgery, Taizhou Orthopedics Hospital, 388 Yanghe Road, Chengdong Street, Wenling City, Zhejiang Province, China;2. Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou City, Zhejiang Province, China;3. Orthopedics Research Institute of Zhejiang University, 88 Jiefang Road, Hangzhou City, Zhejiang Province, China;4. Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 88 Jiefang Road, Hangzhou City, Zhejiang Province, China;1. Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;2. Helmholtz Zentrum München, German Research Center for Environmental Health, Individual Monitoring Service, Munich, Germany;3. Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;1. Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;2. Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;1. St. Joseph''s University Medical Center, Department of Orthopaedic Surgery, 703 Main Street, Paterson, NJ 07503, USA;2. Rutgers New Jersey Medical School, 185 South Orange Ave, Newark, NJ 07103, USA;1. Spine Center, Yodakubo Hospital, 2857 Furumachi, Nagawa, Nagano, 386-0603, Japan;2. Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan |
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| Abstract: | BACKGROUND CONTEXTSpine patients have a higher rate of depression then the general population which may be caused in part by levels of pain and disability from their spinal disease.PURPOSEDetermination whether improvements in health-related quality of life (HRQOL) resulting from successful spine surgery leads to improvements in mental health.STUDY DESIGN/SETTINGThe Canadian Spine Outcome Research Network prospective surgical outcome registry.OUTCOME MEASURESChange between preoperative and postoperative SF12 Mental Component Score (MCS). Secondary outcomes include European Quality of Life (EuroQoL) Healthstate, SF-12 Physical Component Score (PCS), Oswestry Disability Index (ODI), Patient Health Questionaire-9 (PHQ9), and pain scales.METHODSThe Canadian Spine Outcome Research Network registry was queried for all patients receiving surgery for degenerative thoracolumbar spine disease. Exclusion criteria were trauma, tumor, infection, and previous spine surgery. SF12 Mental Component Scores (MCS) were compared between those with and without significant improvement in postoperative disability (ODI) and secondary measures. Multivariate analysis examined factors predictive of MCS improvement.RESULTSEighteen hospitals contributed 3222 eligible patients. Worse ODI, EuroQoL, PCS, back pain and leg pain correlated with worse MCS at all time points. Overall, patients had an improvement in MCS that occurred within 3 months of surgery and was still present 24 months after surgery. Patients exceeding Minimally Clinically Important Differences in ODI had the greatest improvements in MCS. Major depression prevalence decreased up to 48% following surgery, depending on spine diagnosis.CONCLUSIONSLarge scale, real world, registry data suggests that successful surgery for degenerative lumbar disease is associated with reduction in the prevalence of major depression regardless of the specific underlaying diagnosis. Worse baseline MCS was associated with worse baseline HRQOL and improved postoperatively with coincident improvement in disability, emphasizing that mental wellness is not a static state but may improve with well-planned spine surgery. |
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