Does comorbid depression and anxiety portend poor long-term outcomes following surgery for lumbar spondylolisthesis? Five-year analysis of the Quality Outcomes Database
Document Type
Article
Abstract
OBJECTIVE: Depression and anxiety are associated with poor outcomes following spine surgery. However, the influence of these conditions on achieving a minimal clinically important difference (MCID) following lumbar spine surgery, as well as the potential compounding effects of comorbid depression and anxiety, is not well understood. This study explores the impact of comorbid depression and anxiety on long-term clinical outcomes following surgical treatment for degenerative lumbar spondylolisthesis. METHODS: This study was a retrospective analysis of the multicenter, prospectively collected Quality Outcomes Database (QOD). Patients with surgically treated grade 1 lumbar spondylolisthesis from 12 centers were included. Preoperative baseline characteristics and comorbidities were recorded, including self-reported depression and/or anxiety. Pre- and postoperative patient-reported outcomes (PROs) were recorded: the numeric rating scale (NRS) score for back pain (NRS-BP), NRS score for leg pain (NRS-LP), Oswestry Disability Index (ODI), and EQ-5D. Patients were grouped into 3 cohorts: no self-reported depression or anxiety (non-SRD/A), self-reported depression or anxiety (SRD/A), or presence of both comorbidities (SRD+A). Changes in PROs over time, satisfaction rates, and rates of MCID were compared. A multivariable regression analysis was performed to establish independent associations. RESULTS: Of the 608 patients, there were 452 (74.3%) with non-SRD/A, 81 (13.3%) with SRD/A, and 75 (12.3%) with SRD+A. Overall, 91.8% and 80.4% of patients had ≥ 24 and ≥ 60 months of follow-up, respectively. Baseline PROs were universally inferior for the SRD+A cohort. However, at 60-month follow-up, changes in all PROs were greatest for the SRD+A cohort, resulting in nonsignificant differences in absolute NRS-BP, NRS-LP, ODI, and EQ-5D across the 3 groups. MCID was achieved for the SRD+A cohort at similar rates to the non-SRD/A cohort. All groups achieved > 80% satisfaction rates with surgery without significant differences across the cohorts (p = 0.79). On multivariable regression, comorbid depression and anxiety were associated with worse baseline PROs, but they had no impact on 60-month PROs or 60-month achievement of MCIDs. CONCLUSIONS: Despite lower baseline PROs, patients with comorbid depression and anxiety achieved comparable rates of MCID and satisfaction after surgery for lumbar spondylolisthesis to those without either condition. This quality-of-life benefit was durable at 5-year follow-up. These data suggest that patients with self-reported comorbid depression and anxiety should not be excluded from consideration of surgical intervention and often substantially benefit from surgery.
Medical Subject Headings
Humans; Female; Male; Spondylolisthesis (surgery, complications); Lumbar Vertebrae (surgery); Middle Aged; Depression (epidemiology, psychology); Anxiety (epidemiology, psychology); Retrospective Studies; Comorbidity; Treatment Outcome; Aged; Databases, Factual; Patient Reported Outcome Measures; Adult
Publication Date
11-1-2024
Publication Title
Journal of neurosurgery. Spine
E-ISSN
1547-5646
Volume
41
Issue
5
First Page
579
Last Page
588
PubMed ID
39241264
Digital Object Identifier (DOI)
10.3171/2024.5.SPINE24325
Recommended Citation
DiDomenico, Joseph; Farber, S Harrison; Virk, Michael S.; Godzik, Jakub; Johnson, Sarah E.; Bydon, Mohamad; Mummaneni, Praveen V.; Bisson, Erica F.; Glassman, Steven D.; Chan, Andrew K.; Chou, Dean; Fu, Kai-Ming; Shaffrey, Christopher I.; Asher, Anthony L.; Coric, Domagoj; Potts, Eric A.; Foley, Kevin T.; Wang, Michael Y.; Knightly, John J.; Park, Paul; Shaffrey, Mark E.; Slotkin, Jonathan R.; Haid, Regis W.; Uribe, Juan S.; and Turner, Jay D., "Does comorbid depression and anxiety portend poor long-term outcomes following surgery for lumbar spondylolisthesis? Five-year analysis of the Quality Outcomes Database" (2024). Neurosurgery. 2172.
https://scholar.barrowneuro.org/neurosurgery/2172