103. Effects of anterior cervical discectomy and fusion on mental health

Abstract

<h3>BACKGROUND CONTEXT</h3> Cervical disc disease can lead to debilitating symptoms which can affect a patient both physically and mentally. Studies have shown anterior cervical discectomy and fusion (ACDF) is an appropriate intervention that can alleviate symptoms of cervical spondylosis more quickly than conservative management and often improves clinical function. In theory, this alleviation of symptoms should lead to increased mental well-being of afflicted patients. While such a surgery may ameliorate a patient's physical ailments, the psychosocial impact of both a patient's symptoms, as well as the impact of surgery, cannot be ignored. It has been consistently stated in the current literature that preoperative depression can lead to worse postoperative outcomes after spinal surgery. However, diagnoses of new mental health disorders after surgery, and the time at which they occur, are less understood. <h3>PURPOSE</h3> The primary objective of this study is to determine the incidence of newly diagnosed mental health disorders between patients with cervical spondylosis who underwent ACDF compared to those who did not. This study aims to identify which mental health diagnoses a patient may be predisposed to after an ACDF, as well as to determine how long it takes to develop a new mental health disorder in each group. <h3>Methods</h3> A retrospective cohort study was performed of 5,924 patients with a diagnosis of cervical spondylosis within a single large health care system between January 2015 and December 2019. Only patients greater than 18 years of age with a diagnosis of cervical spondylosis were included in this study. 493 patients with a mental health diagnosis prior to diagnosis of cervical spondylosis, or a prior ACDF, were excluded. The final study group included for analysis consisted of 5,431 patients which was split into two cohorts depending on whether or not they underwent ACDF during the study period (ACDF cohort: n=189; no surgery cohort: n=5,242). Demographic analysis was performed for each cohort. A chi-square test was used to compare the incidence of new mental health diagnoses in each cohort, and a Mann-Whitney U test was used to compare the length of time until diagnosis of the new mental health disorders. <h3>Results</h3> A total of 5,431 patients (3,229 females, 2,202 males) ranging from 18 to 111 years old were included for review in our study. Of these patients, 189 (3.4%) with an average age of 58.8 years underwent ACDF compared to 5,242 (96.5%) with an average age of 64.0 years who did not. Overall, 1,056 patients (19.4%) developed a new mental health diagnosis. The incidence of new mental health diagnoses after surgery within the ACDF cohort was 31.2% (n=59) compared to an incidence of 19.0% (n=997) in the cohort that did not undergo surgery (p<0.001). The average time to diagnosis of a new mental health disorder was 468 days for those who underwent ACDF compared to 903 days for the nonsurgical cohort (p<0.001). Depression and anxiety were the two most common new mental health diagnoses across both surgical and nonsurgical cohorts. <h3>Conclusions</h3> ACDF for cervical spondylosis is associated with a greater incidence of new mental health diagnoses postoperatively, compared to those who were treated conservatively. Depression and anxiety were the two most common diagnoses across both cohorts, and those who underwent ACDF were diagnosed sooner. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.