Are Preoperative PHQ-9 Scores Predictive of Postoperative Outcomes Improvement Following Anterior Cervical Discectomy and Fusion? James M. Parrish, MPH 1 ; Nathaniel W. Jenkins, MS 1 ; Nadia Hrynewycz, BS 1 ; Thomas Brundage, BS 1 ; Joon Yoo, BA 1 ; Kern Singh 1,2 1 Department of Orthopaedic Surgery, Rush University Medical Center 2 Professor, Co-Director of the Minimally Invasive Spine Institute at Rush University Medical Center; Founder and President, Minimally Invasive Spine Study Group
Transcript
Are Preoperative PHQ-9 Scores Predictive of Postoperative Outcomes Improvement Following
Anterior Cervical Discectomy and Fusion?
James M. Parrish, MPH1; Nathaniel W. Jenkins, MS1; Nadia Hrynewycz, BS1; Thomas Brundage, BS1; Joon Yoo, BA1; Kern Singh1,2
1Department of Orthopaedic Surgery, Rush University Medical Center2Professor, Co-Director of the Minimally Invasive Spine Institute at Rush University Medical Center;
Founder and President, Minimally Invasive Spine Study Group
DisclosuresNathaniel W. Jenkins, MS; James M. Parrish, MPH; Nadia Hrynewycz, BS; Thomas Brundage, BS; Joon Yoo, BA Nothing to disclose
Kern Singh, MD
• Royalties – Zimmer Biomet, Stryker K2M, RTI Surgical, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, Slack Publishing
and arm pain, • Oswestry Disability Index (ODI),• 12-Item Short Form Physical
Component Score (SF-12 PCS)
• Statistical Analyses• Pairwise comparisons• Linear regression
■ PRO scores analyzed■ Among other PRO scores
• MCID was compared■ Chi-Squared analysis
Results
No statistically significant variables at baseline
Results
51 patients had a preoperative PHQ-9 score <5 68 patients had a PHQ-9 score ≥5
Higher PHQ-9 = ↑ preoperative NDI, VAS neck pain, and VAS arm pain scores↓ preoperative SF-12 PCS scores
Same Scores at 1-year follow-up
Results● High PHQ-9 cohort:
○ Greater percent achieved MCID for NDI
● No differences in MCID achievement for:
○ VAS neck pain○ VAS arm pain ○ SF-12 PCS
Discussion
● Patients with worse preoperative mental health:○ Greater preoperative disability and pain○ However, significant long-term improvements in
PROs following ACDF● Patients can expect to have similar 1-year follow-up
clinical outcomes regardless of preoperative PHQ-9 score
ReferencesREFERENCES
1. Adogwa O, Parker SL, Shau DN, Mendenhall SK, Aaronson OS, Cheng JS, et al: Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. Spine J 12:179-185, 2012
2. Adogwa O, Parker SL, Shau DN, Mendenhall SK, Bydon A, Cheng JS, et al: Preoperative Zung depression scale predicts patient satisfaction independent of the extent of improvement after revision lumbar surgery. Spine J 13:501-506, 2013
3. Boswell JF, Thompson-Hollands J, Farchione TJ, Barlow DH: Intolerance of uncertainty: a common factor in the treatment of emotional disorders. J Clin Psychol 69:630-645, 2013
4. Cassin S, Sockalingam S, Hawa R, Wnuk S, Royal S, Taube-Schiff M, et al: Psychometric properties of the Patient Health Questionnaire (PHQ-9) as a depression screening tool for bariatric surgery candidates. Psychosomatics 54:352-358, 2013
5. Chaichana KL, Mukherjee D, Adogwa O, Cheng JS, McGirt MJ: Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy. J Neurosurg Spine 14:261-267, 2011
6. Choi Y, Mayer TG, Williams MJ, Gatchel RJ: What is the best screening test for depression in chronic spinal pain patients? Spine J 14:1175-1182, 2014
7. Farivar SS, Cunningham WE, Hays RD: Correlated physical and mental health summary scores for the SF-36 and SF-12 Health Survey, V.I. Health Qual Life Outcomes 5:54, 2007
8. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al: Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51:1171-1178, 1998
9. Hartung TJ, Friedrich M, Johansen C, Wittchen HU, Faller H, Koch U, et al: The Hospital Anxiety and Depression Scale (HADS) and the 9-item Patient Health Questionnaire (PHQ-9) as screening instruments for depression in patients with cancer. Cancer 123:4236-4243, 2017
10. He J, Xiong W, Li F, Luo W, Gao SC: Depression influences pain and function after cervical disc arthroplasty. J Neurosurg Sci 61:39-45, 2017
11. Herron LD, Turner J, Clancy S, Weiner P: The differential utility of the Minnesota Multiphasic Personality Inventory. A predictor of outcome in lumbar laminectomy for disc herniation versus spinal stenosis. Spine (Phila Pa 1976) 11:847-850, 1986
12. Katz JN, Lipson SJ, Brick GW, Grobler LJ, Weinstein JN, Fossel AH, et al: Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 20:1155-1160, 199513. Katz JN, Stucki G, Lipson SJ, Fossel AH, Grobler LJ, Weinstein JN: Predictors of surgical outcome in degenerative lumbar spinal stenosis. Spine (Phila Pa 1976) 24:2229-2233, 1999
14. Lee JJ, Lee MK, Kim JE, Kim HZ, Park SH, Tae JH, et al: Pain relief scale is more highly correlated with numerical rating scale than with visual analogue scale in chronic pain patients. Pain Physician 18:E195-200, 2015
15. Lobner M, Luppa M, Matschinger H, Konnopka A, Meisel HJ, Gunther L, et al: The course of depression and anxiety in patients undergoing disc surgery: a longitudinal observational study. J Psychosom Res 72:185-194, 2012
16. Manea L, Gilbody S, McMillan D: A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry 37:67-75, 2015
17. Merrill RK, Zebala LP, Peters C, Qureshi SA, McAnany SJ: Impact of Depression on Patient-Reported Outcome Measures After Lumbar Spine Decompression. Spine (Phila Pa 1976) 43:434-439, 2018
18. Miller JA, Derakhshan A, Lubelski D, Alvin MD, McGirt MJ, Benzel EC, et al: The impact of preoperative depression on quality of life outcomes after lumbar surgery. Spine J 15:58-64, 2015
19. Moriarty AS, Gilbody S, McMillan D, Manea L: Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. Gen Hosp Psychiatry 37:567-576, 2015
20. Ng LC, Tafazal S, Sell P: The effect of duration of symptoms on standard outcome measures in the surgical treatment of spinal stenosis. Eur Spine J 16:199-206, 2007
21. Pakarinen M, Vanhanen S, Sinikallio S, Aalto T, Lehto SM, Airaksinen O, et al: Depressive burden is associated with a poorer surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study. Spine J 14:2392-2396, 2014
22. Park SM, Kim HJ, Jang S, Kim H, Chang BS, Lee CK, et al: Depression is Closely Associated With Chronic Low Back Pain in Patients Over 50 Years of age: A Cross-sectional Study Using the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-2). Spine (Phila Pa 1976), 2018
23. Parker SL, Godil SS, Shau DN, Mendenhall SK, McGirt MJ: Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: clinical article. J Neurosurg Spine 18:154-160, 2013
24. Phan K, Moran D, Kostowski T, Xu R, Goodwin R, Elder B, et al: Relationship between depression and clinical outcome following anterior cervical discectomy and fusion. J Spine Surg 3:133-140, 2017
25. Sinikallio S, Aalto T, Airaksinen O, Lehto SM, Kroger H, Viinamaki H: Depression is associated with a poorer outcome of lumbar spinal stenosis surgery: a two-year prospective follow-up study. Spine (Phila Pa 1976) 36:677-682, 2011
26. Skeppholm M, Fransson R, Hammar M, Olerud C: The association between preoperative mental distress and patient-reported outcome measures in patients treated surgically for cervical radiculopathy. Spine J 17:790-798, 2017
27. Sundseth J, Kolstad F, Johnsen LG, Pripp AH, Nygaard OP, Andresen H, et al: The Neck Disability Index (NDI) and its correlation with quality of life and mental health measures among patients with single-level cervical disc disease scheduled for surgery. Acta Neurochir (Wien) 157:1807-1812, 2015
28. Tuck AN, Scribani MB, Grainger SD, Johns CA, Knight RQ: The patient health questionnaire (PHQ-9): an aid to assessment of patient-reported functional outcomes after spinal surgery. Spine J, 2018
29. Tuomainen I, Pakarinen M, Aalto T, Sinikallio S, Kröger H, Viinamäki H, et al: Depression is associated with the long-term outcome of lumbar spinal stenosis surgery: a 10-year follow-up study. Spine J 18:458-463, 2018
30. Urban-Baeza A, Zárate-Kalfópulos B, Romero-Vargas S, Obil-Chavarría C, Brenes-Rojas L, Reyes-Sánchez A: Influence of depression symptoms on patient expectations and clinical outcomes in the surgical management of spinal stenosis. J Neurosurg Spine 22:75-79, 2015
31. Young IA, Cleland JA, Michener LA, Brown C: Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy. Am J Phys Med Rehabil 89:831-839, 2010
