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SPORT study shows poor results in patients with spondylolisthesis, psychological disorders
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Patients with psychological distress disorders — such as depression or anxiety — displayed significantly less improvement after surgery for degenerative spondylolisthesis than patients without these disorders, according to a results based on a cohort of the SPORT study.
“The literature supports the track that those patients who have poor psychological status have a less successful outcome of surgical intervention and spine surgery and, therefore, psychological and emotional status of patients may be a predictor of surgical outcome,” William A. Abdu, MD, said during his presentation at the International Society for the Study of the Lumbar Spine Annual Meeting 2011.
Psychological distress
The researchers gathered 4 years of data on 600 patients from the SPORT degenerative spondylolisthesis cohort. They measured outcomes using SF-36 Mental Health Component Summary (MCS) scores, bodily pain, physical function and Oswestry Disability Index (ODI) results and changes over time.
Abdu and his team combined the randomized and observational patients from the cohort to do an as-treated analysis. There were 391 patients in the surgical group and 210 patients in the nonsurgical group. The team considered patients with SF-36 MCS scores, 35 as having psychological distress (PD).
Overall, 65% had surgery and 12% had PD. The researchers observed that 51 patients in the surgical group had PD vs. 22 patients in the conservatively treated group. It was statistically significant that surgically treated patients with PD had bodily pain and physical function scores that were lower than those without PD. For ODI, a low MCS score had no bearing on either treatment group.
For patients undergoing surgery invertebral disc herniation, those with PD showed outcomes similar to patients without PD. However, patients with PD undergoing nonsurgical treatment showed less improvement than patients without PD.
Limitations
A limitation of the study was that because it was a subgroup analysis, “there are potential compounding effects that perhaps are unmeasured and unaccounted for,” according to Abdu.
“From the study design point of view, I think that what we have learned from this is that it is really important to be clear about the findings of populations of spine patients in any database or registry and that you specifically control for baseline differences when possible, including comorbidities and other variables that may impact outcome,” Abdu said. – by Renee Blisard
Reference:
- Davis G, Spratt KF, Abdu WA, Moschetti W, Zhao W, et al. Degenerative spondylolisthesis in the spine patient outcomes research trial (SPORT): Does psychological distress affect treatment outcome? Paper #61. Presented at the International Society for the Study of the Lumbar Spine Annual Meeting 2011. June 14-18. Gothenburg, Sweden.
- William A. Abdu, MD, can be reached at The Spine Center, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Lebanon, NH 03756; 603-650-2225; email: william.a.abdu@dartmouth.edu.
- Disclosure: Abdu has no relevant conflicts of interest.
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This is yet another example of the rich data source from the SPORT study. It is commonly assumed that psychological distress negatively affects treatment outcomes. This was true in the intervertebral disc herniation cohort of the SPORT study. Interestingly, the same observation did not generalize to the degenerative spondylolisthesis cohort. Thus, outcomes with some spinal disorders are more susceptible to influence by psychological distress than others.
— Scott D. Boden, MD
Orthopedics
Today Spine Section Editor
Director, Emory Spine Center
Atlanta,
Ga.
Disclosure: Boden is a consultant to Medtronic.