By: 1 August 2012

A new study published in The Spine Journal has looked at predicting patient outcomes following spinal surgery by performing a simple, pre-op psychological test.

In “Preoperative Zung Depression Scale Predicts Outcome After Revision Lumbar Surgery for Adjacent Segment Disease, Recurrent Stenosis and Pseudoarthrosis,” the authors conclude that the extent of preoperative depression is an independent predictor of functional outcome after revision lumbar surgery for pseudarthrosis, recurrent stenosis and adjacent segment disease (ASD).

One hundred fifty patients undergoing revision neural decompression and instrumented fusion for ASD (n550), pseudarthrosis (n547), or same-level recurrent stenosis (n553) were included in this study. A Preoperative Zung Self-Reported Depression Scale score was assessed for all patients. Preoperative and two-year postoperative visual analog scale for back pain and leg pain scores and Oswestry Disability Index (ODI) were assessed. The association between preoperative Zung Depression Scale score and two-year improvement in disability was assessed via multivariate regression analysis.

Compared to preoperative status, a score on the visual analog scale for back pain (VAS-BP) was significantly improved two years after surgery for ASD (8.7261.85 vs. 3.9262.84, p5.001), pseudoarthrosis (7.3160.81 vs. 5.0662.64, p5.001), and same-level recurrent stenosis (9.2861.00 vs. 5.0062.94, p5.001). Two-year ODI was also significantly improved after surgery for ASD (28.7269.64 vs. 18.48611.31, p5.001), pseudoarthrosis (29.7465.35 vs. 25.4266.00, p5.001), and same-level recurrent stenosis (36.0166.00 vs. 21.75612.07, p5.001). Independent of age, BMI, symptom duration, smoking, comorbidities and level of preoperative pain and disability, increasing preoperative Zung depression score was significantly associated with less two-year improvement in disability (ODI) after revision surgery for ASD, pseudoarthrosis and recurrent stenosis.
Based on their results, the authors suggest that future comparative effectiveness studies assessing outcomes after revision lumbar surgery should account for depression as a potential confounder. Also, the Zung depression questionnaire may help risk-stratify patients presenting for revision lumbar surgery.

In an accompanying commentary, “Revision lumbar surgery and revisiting the role of preoperative depression screening,” Eugene J. Carragee, MD and Connor J. Telles, MD applaud the “illuminating” and thorough study. They go on to suggest that some patients identified as having ASD actually may be misunderstood or misdiagnosed because psychosocial issues, such as depression or drug use, may have been present all along.

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