P66. The impact of anxiety/depression on outcomes following 1-2 level anterior cervical surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Outcomes after anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) are likely impacted by the mental state of a patient during recovery. Psychologic factors such as anxiety/depression might negatively impact outcomes for a subset of patients. <h3>PURPOSE</h3> To elucidate whether anxiety/depression affect outcomes following 1-2 level anterior cervical surgery (ACDF or CDR) at short-term and final follow-up. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected data. <h3>PATIENT SAMPLE</h3> Patients who underwent 1-2 level ACDF/CDR for cervical radiculopathy/myelopathy and had health related quality of life scores (HRQOLs) at 6 weeks, 3 months and 6 months out from surgery. <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROMs) - 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. <h3>METHODS</h3> Duration of symptoms prior to surgery was recorded. HRQOLs, including NDI, SF-12 and VAS arm and neck were followed. Classic radiographic measurements of C2-C7 cob 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 whether they were diagnosed with anxiety/depression (A/D cohort) or not (non-A/D cohort). We compared outcome scores at each time point to determine if there was a difference in time to recovery for A/D patients.We tested normality of data using a Kolmogrov-Smirnov test. Student's t-test or Mann-Whitney test were used to compare normally and non-normally distributed HRQOLs respectively at each time point between the two cohorts. <h3>RESULTS</h3> There were 82 patients with at least 6-month follow-up (mean age 51.4±11.1 years old, 40 female). There were 16 patients in the A/D cohort. There were no significant differences in age (p=0.14), baseline radiographic parameters (all p>0.05), duration of symptoms (p=0.63) or preop HRQOLs (all p>0.77) between the A/D versus non-A/D. At 2 weeks, VAS-neck (p=0.04) and SF-12 MCS (p < 0.001) were worse for the A/D cohort. At 6 weeks, SF-12 MCS (p < 0.03) was less for the A/D cohort. At 3 months, SF-12 MCS (p<0.001) was worse for the A/D cohort. At final follow-up the only HRQOL that was statistically significant different between the cohorts was SF-12 MCS (54.5±8.4 vs 43.4±10.3, p<0.001) which was worse for the A/D cohort. <h3>CONCLUSIONS</h3> The impact of anxiety/depression on outcomes after 1-2 level ACDF/CDR is minimal. Specific HRQOL measures for mental health like SF-12 MCS will likely be lower in this population as we found within our dataset. Overall outcomes for patients with anxiety/depression mirror positive outcomes for those without these comorbid conditions after 1-2 level ACDF/CDR. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.