Study Examines Role of Mental Health on Spine Surgery Results

It has long been known that people who suffer from depression, anxiety and other mood disorders have a greater propensity for neck and back pain. What has not been investigated has been whether that mental status has an impact on the success of the surgery.

Now a team of researchers from Singapore General Hospital’s Department of Orthopaedic Surgery have set out to do that. Based on their examination of over 100 patients who underwent single-level anterior cervical discectomy and fusion, they determined that there was no correlation between the patient’s pre-surgical mental health and their post-operative improvements.

The research results were published in a recent edition of the scientific journal Spine. Titled “Poor Baseline Mental Health Does Not Influence Improvement in Patient-reported Outcomes, Satisfaction, and Return to Work Two Years After Single-level Anterior Cervical Discectomy and Fusion,” the analysis of whether a link existed between depression prior to surgery for cervical spondylotic myelopathy and the surgery’s outcome will likely inform much of the way that spine surgeons approach patients with identified mental health issues in the future.

According to lead author Graham Goh, MBBS, MRCS (Edin), the decision to pursue the research was driven by an observation that some patients who had gone through the surgery reported that they had not experienced the improvements in pain and disability that they had hoped for.

“Using the wealth of data on spine surgery outcomes that we had collected over more than 10 years, we began identifying potential preoperative risk factors for poorer outcome. Depression and anxiety are known predictors for the onset and severity of disabling neck and back pain, hence we had concerns that a patient’s preoperative mental health status would influence his/her postoperative outcome after cervical spine surgery.”

Despite the fact that there was a reason to believe that patient with poor mental health would show less improvement, what the researchers found was that the degree of improvement that those patients experienced was roughly the same as that of those without mental health issues.

“Both groups experienced a clinically significant improvement and were equally satisfied after ACDF. Moreover, patients with psychological distress preoperatively had a greater improvement in mental health postoperatively.”

Based on their findings, the scientists are suggesting that physicians assessing patients prior to surgery can do some simple screening for depression, and if they find that patients are suffering from a mild disorder they can suggest separate therapy in order to provide even greater improvements in quality of life, but that not doing so would not in any way take away from the relief provided by the surgery itself.

“The results of this study show that mental health improves in patients with degenerative cervical myelopathy who underwent ACDF, together with a reduction in pain and disability. Surgical treatment for myelopathy may work synergistically with mental health treatments to improve the quality of life to a greater extent than might be seen with either isolated intervention.”

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