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Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis.
Spine J. 2012 Mar; 12(3):179-85.SJ

Abstract

BACKGROUND CONTEXT

Persistent back pain and leg pain after index surgery is distressing to patients and spinal surgeons. Revision surgical treatment is technically challenging and has been reported to yield unpredictable outcomes. Recently, affective disorders, such as depression and anxiety, have been considered potential predictors of surgical outcomes across many disease states of chronic pain. There remains a paucity of studies assessing the predictive value of baseline depression on outcomes in the setting of revision spine surgery.

PURPOSE

To assess the predictive value of preoperative depression on 2-year postoperative outcome after revision lumbar surgery for symptomatic pseudarthrosis, adjacent segment disease (ASD), and same-level recurrent stenosis.

STUDY DESIGN

Retrospective cohort study.

PATIENT SAMPLE

One hundred fifty patients undergoing revision surgery for symptomatic ASD, pseudarthrosis, and same-level recurrent stenosis.

OUTCOME MEASURES

Patient-reported outcome measures were assessed using an outcomes questionnaire that included questions on health-state values (EQ-5D), disability (Oswestry Disability Index [ODI]), pain (visual analog scale), depression (Zung Self-Rating Depression Scale), and 12-Item Short Form Health Survey physical and mental component scores.

METHODS

One hundred fifty patients undergoing revision neural decompression and instrumented fusion for ASD (n=50), pseudarthrosis (n=47), or same-level recurrent stenosis (n=53) were included in this study. Preoperative Zung Self-Reported Depression Scale score was assessed for all patients. Preoperative and 2-year postoperative visual analog scale for back pain and leg pain scores and ODI were assessed. The association between preoperative Zung Depression Scale score and 2-year improvement in disability was assessed via multivariate regression analysis.

RESULTS

Compared to preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (8.72±1.85 vs. 3.92±2.84, p=.001), pseudoarthrosis (7.31±0.81 vs. 5.06±2.64, p=.001), and same-level recurrent stenosis (9.28±1.00 vs. 5.00±2.94, p=.001). Two-year ODI was also significantly improved after surgery for ASD (28.72±9.64 vs. 18.48±11.31, p=.001), pseudoarthrosis (29.74±5.35 vs. 25.42±6.00, p=.001), and same-level recurrent stenosis (36.01±6.00 vs. 21.75±12.07, p=.001). Independent of age, BMI, symptom duration, smoking, comorbidities, and level of preoperative pain and disability, increasing preoperative Zung depression score was significantly associated with less 2-year improvement in disability (ODI) after revision surgery for ASD, pseudoarthrosis, and recurrent stenosis.

CONCLUSIONS

Our study suggests that the extent of preoperative depression is an independent predictor of functional outcome after revision lumbar surgery for ASD, pseudoarthrosis, and recurrent stenosis. Future comparative effectiveness studies assessing outcomes after revision lumbar surgery should account for depression as a potential confounder. The Zung depression questionnaire may help risk stratify patients presenting for revision lumbar surgery.

Authors+Show Affiliations

Department of Neurosurgery, The Spinal Column Surgical Quality and Outcomes Research Laboratory, Vanderbilt University Medical Center, 4347 Village at Vanderbilt, Nashville, TN 37232-8618, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21937282

Citation

Adogwa, Owoicho, et al. "Preoperative Zung Depression Scale Predicts Outcome After Revision Lumbar Surgery for Adjacent Segment Disease, Recurrent Stenosis, and Pseudarthrosis." The Spine Journal : Official Journal of the North American Spine Society, vol. 12, no. 3, 2012, pp. 179-85.
Adogwa O, Parker SL, Shau DN, et al. Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. Spine J. 2012;12(3):179-85.
Adogwa, O., Parker, S. L., Shau, D. N., Mendenhall, S. K., Aaronson, O. S., Cheng, J. S., Devin, C. J., & McGirt, M. J. (2012). Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. The Spine Journal : Official Journal of the North American Spine Society, 12(3), 179-85. https://doi.org/10.1016/j.spinee.2011.08.014
Adogwa O, et al. Preoperative Zung Depression Scale Predicts Outcome After Revision Lumbar Surgery for Adjacent Segment Disease, Recurrent Stenosis, and Pseudarthrosis. Spine J. 2012;12(3):179-85. PubMed PMID: 21937282.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative Zung Depression Scale predicts outcome after revision lumbar surgery for adjacent segment disease, recurrent stenosis, and pseudarthrosis. AU - Adogwa,Owoicho, AU - Parker,Scott L, AU - Shau,David N, AU - Mendenhall,Stephen K, AU - Aaronson,Oran S, AU - Cheng,Joseph S, AU - Devin,Clinton J, AU - McGirt,Matthew J, Y1 - 2011/09/21/ PY - 2011/02/16/received PY - 2011/05/17/revised PY - 2011/08/04/accepted PY - 2011/9/23/entrez PY - 2011/9/23/pubmed PY - 2012/7/24/medline SP - 179 EP - 85 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 12 IS - 3 N2 - BACKGROUND CONTEXT: Persistent back pain and leg pain after index surgery is distressing to patients and spinal surgeons. Revision surgical treatment is technically challenging and has been reported to yield unpredictable outcomes. Recently, affective disorders, such as depression and anxiety, have been considered potential predictors of surgical outcomes across many disease states of chronic pain. There remains a paucity of studies assessing the predictive value of baseline depression on outcomes in the setting of revision spine surgery. PURPOSE: To assess the predictive value of preoperative depression on 2-year postoperative outcome after revision lumbar surgery for symptomatic pseudarthrosis, adjacent segment disease (ASD), and same-level recurrent stenosis. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: One hundred fifty patients undergoing revision surgery for symptomatic ASD, pseudarthrosis, and same-level recurrent stenosis. OUTCOME MEASURES: Patient-reported outcome measures were assessed using an outcomes questionnaire that included questions on health-state values (EQ-5D), disability (Oswestry Disability Index [ODI]), pain (visual analog scale), depression (Zung Self-Rating Depression Scale), and 12-Item Short Form Health Survey physical and mental component scores. METHODS: One hundred fifty patients undergoing revision neural decompression and instrumented fusion for ASD (n=50), pseudarthrosis (n=47), or same-level recurrent stenosis (n=53) were included in this study. Preoperative Zung Self-Reported Depression Scale score was assessed for all patients. Preoperative and 2-year postoperative visual analog scale for back pain and leg pain scores and ODI were assessed. The association between preoperative Zung Depression Scale score and 2-year improvement in disability was assessed via multivariate regression analysis. RESULTS: Compared to preoperative status, VAS-BP was significantly improved 2 years after surgery for ASD (8.72±1.85 vs. 3.92±2.84, p=.001), pseudoarthrosis (7.31±0.81 vs. 5.06±2.64, p=.001), and same-level recurrent stenosis (9.28±1.00 vs. 5.00±2.94, p=.001). Two-year ODI was also significantly improved after surgery for ASD (28.72±9.64 vs. 18.48±11.31, p=.001), pseudoarthrosis (29.74±5.35 vs. 25.42±6.00, p=.001), and same-level recurrent stenosis (36.01±6.00 vs. 21.75±12.07, p=.001). Independent of age, BMI, symptom duration, smoking, comorbidities, and level of preoperative pain and disability, increasing preoperative Zung depression score was significantly associated with less 2-year improvement in disability (ODI) after revision surgery for ASD, pseudoarthrosis, and recurrent stenosis. CONCLUSIONS: Our study suggests that the extent of preoperative depression is an independent predictor of functional outcome after revision lumbar surgery for ASD, pseudoarthrosis, and recurrent stenosis. Future comparative effectiveness studies assessing outcomes after revision lumbar surgery should account for depression as a potential confounder. The Zung depression questionnaire may help risk stratify patients presenting for revision lumbar surgery. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/21937282/Preoperative_Zung_Depression_Scale_predicts_outcome_after_revision_lumbar_surgery_for_adjacent_segment_disease_recurrent_stenosis_and_pseudarthrosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(11)00536-5 DB - PRIME DP - Unbound Medicine ER -