Even subclinical depressive symptoms can negatively affect LSS surgery outcomes

Research showed psychological factors, such as depression, put patients at an increased risk for poorer functional ability postoperatively.

Depression, even when its symptoms are mild, can lead to poorer health and functional outcomes following lumbar spinal stenosis surgery, according to results of a prospective observational study.

Maarit Pakarinen, MD, and colleagues studied 102 patients with radiologically and clinically defined lumbar spinal stenosis (LSS) who underwent decompressive surgery. The purpose of the study, which was published in The Spine Journal, was to analyze the effect of depressive symptoms on the outcomes of surgery at the 5-year follow-up.

Depression may affect outcomes

“Even subclinical depressive symptoms seem to have an effect on the outcome of surgery. Screening for these symptoms before the surgery and during the postoperative rehabilitation period is important in order to recognize the patients who might benefit from enhanced psychosocial support as a part of their treatment.” Pakarinen told Spine Surgery Today.

“In the future, it would be important to assess in RCTs (randomized controlled trials) whether this kind of psychosocial support as a part of rehabilitation would improve the outcomes of surgery,” Pakarinen said.

To be included in the study, patients had to have severe pain in the back, buttocks and/or lower extremities. They also needed to have radiographic evidence of compression of the cauda equina or exiting nerve roots by degenerative changes and there needed to be a surgeon’s clinical evaluation of the patient having degenerative LSS requiring operative treatment for inclusion in the study, Pakarinen and colleagues noted in the study.

Questionnaire to assess patients

The final study included 62 patients who underwent surgery. There were no differences in the patients’ baseline Oswestry Disability Index (ODI), Beck Depression Inventory (BDI) and VAS scores, as well as their walking distance, age, gender, or marital status, Pakarinen and colleagues wrote.

Pakarinen and colleagues collected data from patients and used a questionnaire before surgery and at 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Questions concerning sociodemographic background, lifestyle and health were included in the preoperative questionnaire and all patients were administered the same questionnaire.

Depression cannot be ignored

At the 5-year follow-up, 74 patients from the original group of participants responded to the questionnaire for an attrition of 27.5%. After those with missing BDI data were excluded, this left a final sample size of 62 patients.

Pakarinen and colleagues reported the mean age of the study group at the 5-year follow-up was 67 years, 35% of the patients were men and 62% of patients were married or living with a partner.

Fifteen percent of patients had elevated depressive symptoms with a BDI score of ≥15 at the 5-year follow-up.

It was found that patients with a high depressive burden also had higher ODI scores than patients with a low depressive burden at all follow-up points, based on results of the study. The depressive burden was estimated by summing all individual BDI scores and performing statistical analyses that included cross-sectional group comparisons and linear regression analyses, according to the study.

“To conclude, our results strongly suggest that even subclinical depressive symptoms in LSS patients should not be ignored at any phase of the rehabilitation period,” Pakarinen and colleagues wrote. – by Robert Linnehan

Reference:

Pakarinen M. Spine J. 2014;doi:http://dx.doi.org/10.1016/j.spinee.2014.01.047.

For more information:

Maarit Pakarinen, MD, can be reached at the University of Finland School of Medicine, Tulliportinkatu 1, 80130 Joensuu, Finland; email: maarit.pakarinen@kuh.fi.

Disclosure: The authors have no relevant financial disclosures.