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Tachibana N, Doi T, Nakajima K, Nakamoto H, Miyahara J, Nagata K, Nakarai H, Tozawa K, Ohtomo N, Sakamoto R, Kato S, Taniguchi Y, Matsubayashi Y, Tanaka S, Oshima Y. Does Surgical Treatment Affect the Degree of Anxiety or Depression in Patients With Degenerative Cervical Myelopathy? Global Spine J 2023; 13:2479-2487. [PMID: 35349781 PMCID: PMC10538321 DOI: 10.1177/21925682221088549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Preoperative mental state has been reported as one of the factors affecting the surgical outcomes of spine surgery, but few studies have examined in detail how patients' mental state is affected by spine surgery. The purpose of this study was to investigate using the Hospital Anxiety and Depression Scale (HADS) whether surgery improves preoperative depression and anxiety in patients with degenerative cervical myelopathy. METHODS We investigated patient-reported outcomes (Mental Component Summary, Physical Component Summary of SF-12 Health Survey, and EQ-5D, Neck Disability Index, JOACMEQ, satisfaction with treatment) and HADS one year after surgery, comparing them before and after surgery between April 2017 and February 2020. Among the cases diagnosed as preoperative anxiety and depression, we additionally compared the patient-reported outcomes based on the presence or absence of postoperative improvement in mental state, having also investigated the correlation between patient-reported outcomes and HADS for sub-analysis. RESULTS Among the 99 patients eligible for inclusion in the present study, we found that patient-reported outcomes and the HADS scores improved significantly after surgery. There was a moderate correlation between the amount of change in HADS-D score before and after surgery and the amount of change in NDI (moderate, r = .41), NRS of neck (moderate, r = .46), and JOACMEQ (cervical spine function; moderate, r = .43, upper extremity function; moderate, r = .41, QOL; moderate, r = .41). CONCLUSIONS We found that surgical treatment for patients with degenerative cervical myelopathy may improve postoperative anxiety and depression as well as other patient-reported outcomes.
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Affiliation(s)
- Naohiro Tachibana
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junya Miyahara
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kosei Nagata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Nakarai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichiro Tozawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryuji Sakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Change in Physical and Mental Quality-of-Life between the Short- and Mid-Term Periods after Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Cohort Study with Minimum 5 Years Follow-up. J Clin Med 2022; 11:jcm11175230. [PMID: 36079160 PMCID: PMC9457037 DOI: 10.3390/jcm11175230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
The mid-term surgical outcomes of cervical spondylotic myelopathy (CSM), evaluated using the cervical Japanese Orthopedic Association (cJOA) score, are reported to be satisfactory. However, there remains room for improvement in quality-of-life (QOL), especially after short-term follow-up. We aimed to demonstrate changes in mental and physical QOL between short- and mid-term follow-ups and determine the predictive factors for deterioration of QOL. In this retrospective cohort study, 80 consecutive patients underwent laminoplasty for CSM. The outcome measures were Short Form-36 Physical Component Summary (PCS), Mental Component Summary (MCS), and cJOA scores. PCS and MCS scores were compared at the 2- and 5-year postoperative time points. Additionally, a multivariate logistic regression model was used to identify the predictive factors for deterioration. Significant factors in the logistic regression analysis were analyzed using receiver-operating characteristic curves. The results showed that MCS scores did not deteriorate after 2 years postoperatively (p = 0.912). Meanwhile, PCS significantly declined between 2 and 5 years postoperatively (p = 0.008). cJOA scores at 2 years postoperatively were significantly associated with PCS deterioration at 2-year follow-up. In conclusion, only physical QOL might show deterioration after short-term follow-up. Such deterioration is likely in patients with a cJOA score <13.0 at 2 years postoperatively.
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Xia C, Shi F, Chen C, Lv J, Chen Q. Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7696209. [PMID: 35449847 PMCID: PMC9017450 DOI: 10.1155/2022/7696209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 12/13/2022]
Abstract
Objective To compare the clinical efficacy and safety of anterior cervical decompression and segmental fusion and posterior expansive canal plasty in the treatment of multisegment cervical myelopathy. Methods Retrospective analysis was performed of 56 cases of multisegment cervical myelopathy patients admitted from July 2018 to June 2021, 32 male patients and 24 females, aged 56.9 ± 12.8 years with an average duration of 10.6 ± 3.2 years. All patients' preoperative imaging examination revealed multiple-segmented cervical disc herniation and had clinical manifestations of cervical myelopathy. Results No neurovascular complications occurred in both groups, and 24 to 36 months of follow-up (mean 28.6 months) were obtained. The height of the cervical spondylosis segment was higher than that 2 weeks after surgery (p < 0.05), and the curvature of the cervical spine was significantly lower than that before surgery. There was no statistical significance in the height of the anterior column and curvature of the cervical vertebra at 2 weeks after surgery and at the last follow-up (p > 0.05). There were statistically significant differences in anterior curvature of the cervical spine between the two groups at 2 weeks after surgery and the last follow-up (p < 0.05). Japanese Orthopaedic Association (JOA) scores in both groups recovered significantly after surgery. At 3 months and the last follow-up, the improvement rate of JOA score in the anterior approach group was significantly higher than that in the posterior approach group (p < 0.05), and the improvement rate of JOA score in the anterior approach group was also better than that in the posterior approach group (p < 0.05). Conclusion This segmented anterior fusion procedure can effectively restore the anterior cervical column height and can significantly improve spinal cord function compared with posterior spinal canal enlargement plasty, thus could be considered an effective option for the treatment of multisegment cervical myelopathy.
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Affiliation(s)
- Chen Xia
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
| | - Fangfang Shi
- Department of Hematology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
| | - Chuyong Chen
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
| | - Jun Lv
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
| | - Qi Chen
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China
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Tamai K, Suzuki A, Toyoda H, Terai H, Hoshino M, Takahashi S, Hori Y, Yabu A, Nakamura H. Improvements in Mental Well-Being and its Predictive Factors in Patients who Underwent Cervical versus Lumbar Decompression Surgery. Spine Surg Relat Res 2022; 6:10-16. [PMID: 35224241 PMCID: PMC8842360 DOI: 10.22603/ssrr.2021-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/06/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Mental well-being is essential for patient satisfaction. Therefore, a better understanding of the changes in the mental well-being of patients following spinal surgery can be useful to surgeons. We compared the 2-year postoperative change in the mental well-being of patients who underwent cervical and lumbar decompression surgery. Additionally, the predictive factors for improvement in mental well-being associated with both methods were evaluated. Methods The patients who underwent spinal decompression surgery and were followed >2 years postoperatively were enrolled (lumbar cohort: n=111, cervical cohort: n=121). The 36-item Short-Form Health Survey (SF-36) mental component summary (MCS) was set as the mental well-being parameter, and the minimal clinically important difference (MCID) was defined as 4.0. After adjusting the cervical and lumbar cohorts using propensity scores, the improvements in the MCS were compared between the groups using a mixed-effect model. To identify predictors for improvements, the correlation between the MCS changes and preoperative clinical scores was evaluated. Subsequently, multivariate linear regression was applied, which included variables with p<0.10 in the former analysis as explanatory variables, and the change of MCS as the objective variable. Results There were no significant differences in the MCS improvement between the adjusted cervical and lumbar cohorts; 47% and 49%, respectively, had MCS improvement score >MCIDs. However, predictors for the improvement were different between the two cohorts: SF-36 Social functioning in cervical surgery and lower back pain and SF-36 Role physical in lumbar surgery. Conclusions Although there was no significant difference in the improvement in the mental well-being between patients who underwent either cervical or lumbar decompression surgery, less than half of the patients in both groups achieved a meaningful improvement. Preoperative back pain and personal activity were independent predictors in the lumbar cohort, while social functioning was the only predictor in the cervical cohort. Level of evidence: III
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Affiliation(s)
- Koji Tamai
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Akinobu Suzuki
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Hiromitsu Toyoda
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Hidetomi Terai
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Masatoshi Hoshino
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Shinji Takahashi
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Yusuke Hori
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Akito Yabu
- Department of Orthopedics, Osaka City University Graduate School of Medicine
| | - Hiroaki Nakamura
- Department of Orthopedics, Osaka City University Graduate School of Medicine
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Chen X, Li X, Gan Y, Lu Y, Tian Y, Fu Y, Yang H, Liu K, Pan Y, Du X. Is depression the contraindication of anterior cervical decompression and fusion for cervical spondylosis? Front Endocrinol (Lausanne) 2022; 13:1031616. [PMID: 36246923 PMCID: PMC9561543 DOI: 10.3389/fendo.2022.1031616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate whether depression is the contraindication of anterior cervical decompression and fusion (ACDF) for cervical spondylosis. MATERIAL AND METHODS Patients with single-segment cervical spondylosis who underwent ACDF from January 2015 to December 2018 in our department were retrospectively included in this study and divided into two groups. Patients who were diagnosed of depression and prescribed with antidepressant drugs for at least 6 months before surgery were included in the intervention group. Patients without depression were included in the control group. The Beck Depression Inventory (BDI) score was used to evaluate the severity of depression. Visual Analogue Scale (VAS) score, Japanese Orthopeadic Association (JOA) score, Neck Disability Index (NDI), and the 36-Item Short-Form Health Survey (SF-36) were recorded as indexes to assess the pain, cervical spine function, degree of cervical spine injury, and life quality, respectively. The operative time, operative blood loss, hospital stay and complications were also recorded and compared. RESULTS A total of 117 patients were included in this study, involving 32 patients in the intervention group and 85 patients in the control group. No significant differences were found in operative time, operative blood loss, hospital stay and complications between the two groups (P>0.05). The BDI score, VAS score, JOA score, NDI, SF-36 physical component score (SF-36 PCS) and SF-36 mental component score (SF-36 MCS) were all significantly improved at last follow-up in both the two groups. The intervention group showed higher BDI score and SF-36 MCS than the control group at both preoperative and the last follow-up (P<0.05), and the improvements of BDI score and SF-36 MCS were also higher in the intervention group (P<0.05). Although the intervention group showed higher VAS score, NDI, SF-36 PCS and lower JOA score at preoperative and last follow-up, respectively (P<0.05), there were no significant differences in the improvements of these indexes between the two group (P>0.05). CONCLUSIONS Depression is not the contraindication of ACDF for cervical spondylosis. Depression patients who received preoperative antidepressants can achieve similar improvement of clinical symptoms from ACDF with non-depression patients.
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Affiliation(s)
- Xiaolu Chen
- Department of Psychiatry, The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Gan
- Department of Psychiatry, Chongqing Eleventh People’s Hospital, Chongqing, China
| | - Ying Lu
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Yu Tian
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing, China
| | - Yixiao Fu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hanjie Yang
- Department of Neurology, The Thirteenth People’s Hospital of Chongqing, Chongqing, China
| | - Ke Liu
- Department of Emergency, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yinlian Pan
- Department of Medical Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
- *Correspondence: Yinlian Pan, ; Xing Du,
| | - Xing Du
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Yinlian Pan, ; Xing Du,
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Parrish JM, Jenkins NW, Lynch CP, Cha EDK, Brundage TS, Hrynewycz NM, Singh K. Preoperative Physical Function Association With Mental Health Improvement After Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2021; 34:E559-E565. [PMID: 34224424 DOI: 10.1097/bsd.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE This study investigates the influence of physical function and their influence on postoperative depressive symptom scores as measured by Patient Health Questionnaire-9 (PHQ-9) among anterior cervical decompression and fusion (ACDF) patients. BACKGROUND While ACDF is one of the most commonly performed ambulatory surgeries, research is limited on the predictive value of Patient-Reported Outcomes Measurement Information System (PROMIS) scores and their influence on depressive symptoms as measured by the PHQ-9. METHODS A prospectively maintained surgical registry was retrospectively reviewed from March 2016 to January 2019. Inclusion criteria were primary or revision ACDF procedures. Patients were grouped by preoperative PROMIS score (≥35.0, <35.0), with higher scores indicating greater physical function. The χ2 and Student t tests assessed categorical and continuous variables (eg, demographics, perioperative, and postoperative values). A t test evaluated postoperative improvement in PROMIS Physical Function (PF) scores between subgroups among PROMIS PF scores and PHQ-9 score improvement at 6, 12 weeks, 6 months, and 1 year. Linear regression assessed preoperative PROMIS scores influence on PHQ-9 score improvement. RESULTS The 121 subject cohort was 61.2% male with an average age of 49.6±9.8 years. Compared with the PROMIS ≥35.0 group, the PROMIS <35.0 group also had larger improvement of PROMIS scores at 6 weeks. No significant difference in postoperative PHQ-9 improvement was observed between subgroups. There was a negative association between preoperative PROMIS scores and improvement in PROMIS scores at 6, 12 weeks, 6 months, and 1 year. There was a positive association between preoperative PROMIS scores and magnitude of 1-year PHQ-9 change. CONCLUSIONS Individuals with lower preoperative PROMIS PF scores had significantly higher PHQ-9 scores at 1 year. Patients with lower preoperative physical function, as evaluated by PROMIS PF scoring, had greater improvement of mental health at 1 year postoperatively. This suggests that many patients experience multidimensional health benefits after ACDF procedures.
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Affiliation(s)
- James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To elucidate the postoperative time course of improvements in physical and mental well-being in patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA Spinal surgeons should understand the postoperative course in detail. However, data are still needed regarding the time course of improvements in well-being, a fundamental aspect of human life, after cervical surgery for CSM. METHODS One hundred consecutive patients who underwent laminoplasty for CSM, with complete clinical data preoperatively and 3 months and 2 years postoperatively, were enrolled. The Short Form-36 physical component summary (PCS) and mental component summary (MCS) scores were used as parameters of physical and mental well-being, respectively, and 4.0 was defined as the minimal clinically important difference (MCID) for both parameters. RESULTS On average, PCS and MCS scores were significantly improved after surgery (P < 0.001, P=0.004, respectively). Moreover, 64 and 48 patients achieved meaningful improvement (>MCID) in PCS and MCS scores at 3 months postoperatively, with maintained improvement (to 2 yr) in 46/64 (71.9%) and 34/48 patients (70.8%), respectively (PCS vs. MCS: P = 0.912). Additionally, 15 of 36 patients (41.7%) and 8 of 52 patients (15.4%) achieved late improvement (meaningful improvement at 2 yr but not at 3 months) in PCS and MCS scores, respectively (PCS vs. MCS: P = 0.007). In multivariate regression analysis, improvement in cJOA score was significantly associated with PCS improvement, but not MCS improvement, at both 3 months and 2 years (P = 0.001, P > 0.001, respectively). CONCLUSION The overall outcome of physical well-being improvement is decided within 3 months postoperatively, in proportion to the recovery in myelopathy, with a relatively high chance of meaningful improvement over the next 21 months. The outcome of improvement in mental well-being is decided within 3 months postoperatively, independently from the recovery in myelopathy, with a low chance of meaningful improvement over the next 21 months.Level of Evidence: 3.
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