251. Recovery kinetics and final outcomes for 1-2 level anterior cervical surgery is not impacted by anxiety and/or depression

Abstract

<h3>BACKGROUND CONTEXT</h3> The postoperative recovery for anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) may be impacted by affective disorders, especially depression/anxiety. The authors hypothesized that depression/anxiety may slow recovery after anterior cervical surgery (ACDF or CDR) for cervical radiculopathy/myelopathy. <h3>PURPOSE</h3> To evaluate the effect of anxiety and depression on recovery speed after ACDF or CDR. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected data. <h3>PATIENT SAMPLE</h3> Patients who underwent 1-2 level ACDF or CDR for cervical radiculopathy/myelopathy and had at least 1-year follow-up and complete radiographic measurements and health related quality of life scores (HRQOLs) at 6 weeks, 3 months, 6 months and 1 year postoperatively. <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROMs) - HRQOLs including neck disability index (NDI), short-form 12 physical component score (SF-12 PCS), short-form 12 mental component score (SF-12 MCS), PROMIS score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores were follow. <h3>METHODS</h3> Radiographic measurements of C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA) and T1-slope were assessed preoperatively to ensure that the cohorts were similar in terms of alignment. Patients were stratified based on whether they had been diagnosed with anxiety/depression (A/D cohort) or not (non-A/D cohort). We compared recovery kinetics between the A/D versus non-A/D cohort. This was done by normalizing all HRQOLs at each interval time point. The area under the curve (AUC) was then calculated for a plot of the normalized score versus follow-up time point as has been done in previous studies (IHS, Integrated Health State). We used a student's t-test to compare demographic information, radiographic parameters and HRQOLs between the A/D versus non-A/D cohort. <h3>RESULTS</h3> Forty-eight patients with a mean age of 50.0±11.8 years and comprising 22 females were included. All patients had minimum of 1-year follow-up. There were 10 patients in the A/D cohort. There were no significant differences in age (p = 0.18), baseline radiographic parameters (all p>0.10) or preop HRQOLs (all p>0.30) between the A/D versus non-A/D. After normalization there was no significant difference in terms of IHS for A/D versus non-A/D for NDI (0.66±0.38 vs 0.59±0.35, p=0.65), VAS-arm (0.55±0.40 vs 0.36±0.33, p=0.23), VAS-neck (0.55±0.28 vs 0.43±0.27, p=0.24), PROMIS (1.2±0.32 vs 1.3±0.37, p=0.48), SF-12 PCS (1.2±0.26 vs 1.2±0.28, p=0.79) or SF-12 MCS (1.1±0.17 vs 1.1±0.17, p=0.23). Final follow-up outcome scores were also similar for A/D vs non-A/D cohorts for all HRQOLs (all p>0.16). <h3>CONCLUSIONS</h3> We found no negative influence of anxiety/depression on either final-outcome scores or recovery kinetics after 1-2 level ACDF/CDR. Our analysis of IHS shows that the recovery speed after ACDF/CDR were not be impacted by a patient's comorbid anxiety/depression. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.