Patients with depression showed improvement in spine-related disability after surgery
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Key takeaways:
- Patients with depression had worse spine disease severity after surgery vs. patients without depression.
- Patients with and those without depression had similar a magnitude of postoperative improvement.
Although patients with depression presented with and maintained worse spine disease severity after lumbar spine surgery vs. those without depression, researchers found these groups experienced a similar degree of postoperative improvement.
“The association between depression severity and preoperative and postoperative spine disease severity supports the role of impaired mental health in lumbar spine care,” the researchers wrote in the study. “Furthermore, this study highlighted the inconsistent methods used to diagnose preoperative depression, emphasizing the need for standardized methods to assess this comorbidity.”
Researchers performed a systematic review and meta-analysis of studies from several databases that compared patient-reported outcome measures (PROMs) and/or spinal disease severity in patients with vs. those without preoperative depression. The review included data for 21,452 adults (55% women; mean age, 57 years) who underwent surgery for degenerative lumbar spine disease. Median follow-up was 12 months.
Outcomes included standardized mean difference of change in PROMs for disability, pain and physical function from preoperative baseline to postoperative follow-up, as well as preoperative and postoperative differences in absolute disease severity.
Overall, researchers found no significant difference in the standardized mean difference of change in disability, pain and physical function from baseline to follow-up among patients with vs. those without depression.
In addition, patients with preoperative depression had more improvement from baseline to follow-up compared with patients without depression. However, this result was not statistically significant, according to the study.
Researchers also found that patients with preoperative depression had worse baseline and postoperative disability, pain and physical function scores compared with patients without depression.
“The findings of this study may provide timely estimates regarding the implications of comorbid depression for lumbar surgery outcomes,” the researchers wrote in the study. They added, “Further investigations are needed to examine the causal association between spine-related disability and depression as well as the role of perioperative mental health treatments.”
Perspective
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The authors conducted a systematic review of 44 high-quality studies of 21,452 patients with depression compared with patients without depression who had lumbar spine surgery for degenerative conditions. They assessed patient-reported outcomes for disability, pain and physical function, and presence of depression was determined by diagnosis in the patient chart or by multiple different quantitative scales. Of the studies included, 34% had a prospective design and 66% had a retrospective design. Importantly, both groups of patients had postoperative improvements and patients in the depressed group showed an even greater magnitude of improvements, though it was not statistically significant. Patients who were depressed presented with worse spine disease severity, and it remained worse after lumbar spine surgery compared with those without depression.
The take-home points are that although patients with depression often had worse disease severity pre- and post-surgery than patients without depression, they typically experience meaningful improvement in spine-related disability after lumbar spine surgery. There was substantial heterogeneity in the methods used to diagnose depression across studies, and it is difficult to assess the severity of depression and its impact. The authors used sophisticated statistical testing to account for the impact of confounders and comorbid conditions beyond depression on outcomes, but it is important to note nearly half of the studies did not include important covariates including age, comorbidities and baseline symptom severity. Thus, future prospective studies are needed to assess severity of depression with standardized scales, account for all comorbid physical and mental health conditions and severity, and target a preoperative intervention or optimization for patients with moderate to severe depression, determining whether it results in better outcomes for lumbar spine surgery compared with a control group of matched patients who did not receive the intervention. I am pleased to see that patients with depression can benefit from surgery.
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Javeed S, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2023.48565.
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