50. Re-emergence of depressive symptoms and associated risk factors in cervical spine patients

Abstract

<h3>BACKGROUND CONTEXT</h3> Few studies have investigated worsening of depressive symptoms following cervical spine procedures such as anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA). <h3>PURPOSE</h3> To evaluate risk factors associated with worsening depressive symptoms following ACDF or CDA. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> A total of 362 patients undergoing primary, elective, single or multilevel ACDF or CDA procedures. <h3>OUTCOME MEASURES</h3> Demographics, perioperative information, Short Form 12-Item and Veterans RAND Mental Component Summary (SF-12 and VR-12 MCS), Patient Health Questionnaire-9 (PHQ-9), visual analog scale (VAS) for neck and arm, and Neck Disability Index (NDI). <h3>METHODS</h3> A surgical registry was retrospectively reviewed for primary, elective, single or multilevel ACDF or CDA procedures. Demographics and perioperative information were collected and descriptive statistics performed. SF-12 and VR-12 MCS, PHQ-9, VAS for neck and arm, and NDI were collected preoperatively and at 6-weeks, 12-weeks, 6-months, and 1-year postoperatively. Improvement of all outcome measures from preoperative values was evaluated using paired student's t-test. Achievement of minimum clinically important difference (MCID) was evaluated by comparing the difference in preoperative and postoperative scores with the following preestablished values: 4.7 (SF-12 MCS), 8.1 (VR-12 MCS), and 3.0 (PHQ-9). Worsening of depressive symptoms, MCID "drop-off", was defined as patients who demonstrated achievement of an MCID at an earlier postoperative timepoint and subsequently failed to achieve an MCID at a later timepoint. Bivariate poisson regression with robust error variance was performed to determine relative risk of demographic and perioperative characteristics with mental health MCID "drop-off". <h3>RESULTS</h3> Of the eligible 362 patients, mean age was 49.0 years and 58.6% were male with a mean body mass index of 29.1 kg/m2 . Preoperatively 47.2% of patients had a high level of neck pain, 43.2% with high arm pain, 12.9% with a poor PHQ-9 score and 43.9% with a poor SF-12 MCS score. Majority of patients experienced myeloradicular symptoms (81.2%) and had a spinal pathology of herniated nucleus pulposus (85.4%). Majority of procedures were performed at the single level (61.4%) with 80.4% of procedures being ACDF and 19.6% being CDA. Mean operative time was 61.9 minutes with an average estimated blood loss of 40.3mL. The study cohort had a mean length of stay of 18.7 hours. Both SF-12 MCS and PHQ-9 demonstrated significant improvements from preoperative levels at all postoperative timepoints (all p<0.01). VAS neck, VAS arm, and NDI demonstrated significant improvement at all timepoints (all p<0.001). Risk factors associated with a MCID "drop-off" for both SF-12 and VR-12 MCS included a worse preoperative SF-12 PCS (all p<0.05) and workers' compensation (p=0.012) only for SF-12 PCS. <h3>CONCLUSIONS</h3> Cervical spine patients demonstrated significant improvements in mental health, pain, disability, and physical function following cervical procedures. Worse preoperative depressive symptoms and workers' compensation were risk factors for reemergence of postoperative depression. These results may indicate that patients presenting with worse depression may be more susceptible to loss of initial improvements in mental health outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.