Psychological predictors of quality of life after anterior cervical discectomy and fusion for degenerative cervical spine disease

Arthur Wagner,Kaywan Aftahy,Ann-Kathrin Joerger,Stefan Motov,Leonie Zeller,Bernhard Meyer,Youssef Shiban,Ehab Shiban,Nicole Lange

doi:10.1038/s41598-020-70437-9

Abstract

We aimed to identify independent psychological predictors of quality of life (QOL) and functional outcome after anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease. We prospectively included patients undergoing ACDF for degenerative cervical disc herniation and stenosis. Patients completed a structured psychological assessment including the Center for Epidemiological Studies Depression Scale (ADS-K), Post-Traumatic Stress Scale-10 (PTSS-10), State Trait Anxiety Inventory-State Anxiety and - Trait Anxiety (STAI-S and STAI-T) and Anxiety Sensitivity Index-3 (ASI-3) before surgery, after 3 and 12 months. Outcome measures included EuroQol-5D (EQ), Short Form-36 (SF-36) and Oswestry Disability Index (ODI) scores. Of 104 included patients who underwent ACDF between March 2013 and November 2017, 92 completed follow-up after 3 and 12 months. The mean Visual Analogue Scale (VAS) scores for neck pain (− 1.4; p < .001) and arm pain (− 1.8; p = .031) significantly decreased by 12 months. QOL scores significantly increased by 3 months (EQ: + 0.2; p < .001; SF-36 PCS: + 6.2; p < .001; SF-36 MCS: + 2.5; p = .044), a benefit which was retained at 12 months. Linear regression analyses identified statistically significant predictors in preoperative ASI-3, SF-36 MCS and STAI-S for postoperative QOL and ODI scores. There is a benefit for patients in terms of quality of life and function after undergoing surgery for degenerative cervical spine disease. With the ASI-3, SF-36 MCS and STAI-S there exist some predictors for postoperative QOL and ODI scores.

Highlights

We aimed to identify independent psychological predictors of quality of life (QOL) and functional outcome after anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease
While evidence demonstrating the significant influence of a psychological predisposition of patients on QOL and the functional outcome after surgery for degenerative diseases in the thoracolumbar region continues to emerge, to the best of our knowledge, only a few studies have addressed these aspects after ACDF prospectively[11,12,13,14,15]
The psychological profile of patients gathered from the individual scores represented a surrogate index of the patients’ depression and anxiety in light of undergoing surgery of the cervical spine. With this set-up, we hypothesized that our psychological test battery of depression, anxiety and PTSD scores may be used for prediction of QOL increases after ACDF surgery

Summary

Introduction

We aimed to identify independent psychological predictors of quality of life (QOL) and functional outcome after anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease. Degenerative diseases of the cervical spine are known to encompass a variety of pathologies producing pain, disability and impaired health-related quality of life (QOL) Surgical treatment of these pathologies via an anterior cervical discectomy and fusion (ACDF) procedure has been documented with favourable results in an abundant number of case s eries[1,2,3,4,5,6,7]. Most studies with a retrospective design have reported an inverse correlation between preoperative depression scores and the postoperative QOL improvement[16,17,18] One such investigation drew these conclusions from retrospective data, with a limited follow-up time of 7 months in the control group being the primary limitation[16]. Our primary outcome was represented by the relationship between the preoperative psychological baseline scores and QOL after 12 months, as examined by multiple regression analyses

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