The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion

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The aim of this study was to evaluate the prevalence of depressive symptoms and disability pre-operatively, at 3months and at 1year after lumbar spine fusion surgery. Data was extracted from a dedicated lumbar spine fusion register, giving 232 patients (mean age 62years, 158 females) who had undergone instrumented lumbar spine fusion. The frequency of depressive symptoms and disability was evaluated using the Depression Scale (DEPS) and Oswestry Disability Index (ODI). Depressive symptoms were found in 34, 13, and 15% of the patients pre-operatively, at 3months and at 1year after surgery, respectively. The mean DEPS score decreased from 16.2 to 8.6 (p<0.001) in patients who had depressive symptoms pre-operatively, and from 6.1 to 3.8 (p<0.001) in those patients without pre-operative depressive symptoms. The mean ODI values pre-operatively, at 3months and at 1year after surgery were 53, 30, and 23, respectively, in patients with pre-operative depressive symptoms and 41, 23, and 20 in those patients without pre-operative depressive symptoms. The differences between the groups were statistically significant at all time points (p<0.001). One-third of our patients with chronic back pain undergoing spinal fusion had depressive symptoms pre-operatively. The prevalence of depressive symptoms decreased after surgery. Although disability remained higher in those patients who had reported depressive symptoms pre-operatively, disability did decrease significantly in both groups post-operatively. Thus, there is no need to exclude depressive patients from operation, but screening measures and appropriate treatment practises throughout both pre-operative and post-operative periods are encouraged.