Spine Surgeon Norton Leatherman Spine Center Los Angeles, California, United States
Introduction: Anxiety and depression have been associated with worse outcomes on spinal surgery patients. Patients with these comorbidities have been reported to have lower rates of return to work and poorer patient reported outcomes (PROs). Moreover, operative complications such as infection have also been reported as higher in this population. However, given the broad range of pathologies and corresponding interventions in spine surgery, granularity regarding outcomes for these groups is useful. Specifically, the effect of anxiety and depression on the surgical outcomes of patients with high grade lumbar spondylolisthesis remains poorly explored.
Methods: For this study, we conducted a multi-center retrospective analysis of patients who underwent spine surgery for high grade (II and III) spondylolisthesis between 01/01/2017 and 12/31/2019. Preoperative anxiety and depression levels were assessed using self-report and/or response to the EQ-5D Anxiety domain. Postoperative outcomes were evaluated at baseline and at 24 months using the Oswestry Disability Index (ODI), and Numeric Rating Scale (NRS, 0-10) for back and leg pain.
Results: Patients with preoperative anxiety and depression exhibited higher baseline ODI (p=0.001) scores and higher NRS pain scores for back (p=0.000) and leg pain (p=0.007). EQ-5D scores were significantly worse for those anxiety/depression (p=0.000). Similarly, they also reported worse scores at 24 month follow up than those without anxiety and depression. However, their ODI, NRS, and EQ-5D scores did significantly improve at two years postoperatively. Moreover, there was no significant difference in the improvement in NRS scores for leg pain (p=0.445), NRS scores for back pain (p=0.052), or ODI scores (p=0.865) between those with and without anxiety/depression. EQ-5D did seem to improve significantly more in those without anxiety/depression (p=0.000), though it improved in both groups.
Conclusion : Appropriately treated patients with high grade lumbar spondylolisthesis can experience significant improvements in pain and disability despite underlying anxiety or depression.