Pretreatment of Depression before Cervical Spine Surgery Improves Patients' Perception of Postoperative Health Status: A Retrospective, Single Institutional Experience

Previous research has indicated that postoperative pain and functional outcomes are influenced by affective disorders, especially depression. The aim of this retrospective analysis is to assess whether pretreatment of depression before surgery improved patient-reported outcomes measures and overall satisfaction with care. Methods A total of 140 adult patients (pretreated patients: 25; control patients: 115) underwent anterior cervical discectomy and fusion at Duke University Medical Center were included in this study. Of the 140 patients, 25 patients had a known history of depression diagnosed and treated by a board-certified psychiatrist with an antidepressant at least 6 months before surgery. Enrollment criteria included available demographic, surgical, medication, and clinical outcome data. Patients completed the Neck Disability Index (NDI), Short Form-12 (SF-12), and visual analog scale (VAS) before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes were compared between both patient cohorts. Results Baseline characteristics were similar between both cohorts. At baseline there were no significant differences in NDI (P = 0.11), SF-12 physical component score (PCS; P = 0.63), and neck pain VAS (P = 0.80). There were no significant differences in the incidence of nerve root injury (P = 0.00) or durotomy (P = 0.31) between the treatment and control cohorts. At 1 year postoperatively, both cohorts demonstrated similar improvement in neck pain VAS (P = 0.92), NDI (P = 0.32), SF-12 PCS (P = 0.15), and SF-12 mental component score (P = 0.38). These results were durable through 2 years. At 2 years, both the demonstrated similar improvement from baseline in neck pain VAS (P = 0.88), NDI (P = 0.43), SF-12 PCS (P = 0.28), and SF-12 mental component score (P = 0.40). Conclusion Our study suggests that in patients with depression, pretreatment with antidepressants before surgery significantly improves their perception and pain and functional disability.