Psychological predictors of quality of life and functional outcome in patients undergoing elective surgery for degenerative lumbar spine disease

Arthur Wagner, Youssef Shiban, Corinna Wagner, Kaywan Aftahy, Ann-Kathrin Joerger, Bernhard Meyer, Ehab Shiban

February 2020, Volume 29, Issue 2, pp 349 - 359 Original Article Read Full Article

First Online: 14 August 2019

Objective

To quantify the correlation between patients’ psychopathological predisposition, disability and health-related quality of life (QOL) after surgery for degenerative lumbar spine disease.

Methods

We prospectively included patients undergoing decompression for degenerative lumbar spinal stenosis, spondylolisthesis or disc herniation with additional fusion of up to two segments. Patients completed a structured psychological assessment including the Center for Epidemiological Studies Depression Scale (ADS-K), Post-Traumatic Stress Scale–10 (PTSS-10), State Trait Anxiety Inventory–State Anxiety and State Trait Anxiety Inventory–Trait Anxiety (STAI-S and STAI-T) and Anxiety Sensitivity Index–3 (ASI-3) before surgery, after 3 and 12 months. Outcome measures included EuroQol 5D (EQ), Short Form-36 (SF-36) and Oswestry Disability Index (ODI) scores.

Results

In total, 245 patients between March 2013 and November 2017 received surgery, of which 180 (73.5%) fully completed follow-up after 3 months and 12 months. QOL scores significantly increased by 3 months (EQ: +0.2; p < 0.001; SF-36 PCS: +7.0; p < 0.001; SF-36 MCS: +3.3; p = 0.018), a benefit which was retained at 12 months, without statistically significant difference between fused and non-fused patients. Depressed patients exhibited impaired mean scores of EQ (0.58 vs. 0.36; p < 0.001) and ODI mean scores (35.5 vs. 51.9; p < 0.001) at baseline, which significantly improved and converged with scores of non-depressed patients after 12 months. Linear regression analysis identified statistically significant predictors in age, STAI-T and SF-36 MCS for post-operative QOL and disability.

Conclusion

Despite exhibiting pronounced psychological distress preoperatively, patients may significantly benefit from surgery with an outcome equal to psychologically healthy patients after 12 months.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material. [graphic not available: see fulltext]

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