Correlation of mental health with physical function, pain, and disability following anterior lumbar interbody fusion

Abstract

Studies have demonstrated the influence of preoperative mental health on outcomes following spine surgery, but prior literature has not assessed the influence of mental health at time of outcome survey collection. Patients who underwent elective anterior lumbar interbody fusion (ALIF) were identified from a prospective registry. Patient-reported outcomes (PROs) were collected preoperatively and up to 1year postoperatively. Mental health measures studied included 12-item Short Form (SF-12) Mental Component Score (MCS) and Patient Health Questionnaire-9 (PHQ-9). Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), SF-12 Physical Component Score (PCS), visual analog scale (VAS) back and leg pain, and Oswestry Disability Index (ODI) were compared to the mental health measures by Pearson's correlation tests. A total of 166 patients were included. SF-12 MCS demonstrated positive correlation to PROMIS-PF preoperatively (|r|= 0.379) and at 6weeks (|r|= 0.387) (p ≤ 0.016, all). SF-12 MCS demonstrated negative correlation to VAS back at 6months (|r|= 0.359), VAS leg at 6weeks (|r|= 0.475) and 12weeks (|r|= 0.422), and ODI up to 6months postoperatively (|r|= 0.417-0.526) (p ≤ 0.037, all). PHQ-9 negatively correlated with PROMIS-PF at all periods studied (|r|= 0.425-0.587) and SF-12 PCS up to 6months postoperatively (|r|= 0.367-0.642) (p ≤ 0.016, all). PHQ-9 positively correlated to VAS back at 6weeks (|r|= 0.408) and 6months (|r|= 0.411), VAS leg at 6weeks (|r|= 0.344), and ODI up to 6months postoperatively (|r|= 0.321-0.669) (p ≤ 0.034, all). Inferior mental health correlated with inferior pain, function, and disability scores at one or more periods postoperatively. This finding was most consistent for correlation between mental health scores and disability. Optimization of mental health may positively influence outcomes, especially regarding disability, following ALIF.