Pretreatment of Anxiety Before Cervical Spine Surgery Improves Clinical Outcomes: A Prospective, Single-Institution Experience

Abstract

Background: Affective disorders such as depression and anxiety have been shown to contribute to inferior outcomes after spine surgery. A high baseline level of anxiety is associated with refractory postoperative pain and patient dissatisfaction with surgery. The aim of this prospective study is to assess whether the pretreatment of anxiety before spine surgery improves patient reported outcomes 1-year after an anterior cervical discectomy and fusion (ACDF) procedure.

Methods: A total of 27 adult patients with a known history of anxiety disorder (pretreated cohort: 11 patients, control cohort: 16 patients) undergoing ACDF at Duke University Medical Center were included in this study. All patients were diagnosed with an anxiety disorder at least 6 months before surgery by a board-certified psychiatrist. Enrollment criteria included available demographic, surgical, and clinical outcomes data. All patients had prospectively collected patient reported outcomes measures and a minimum 1-year follow-up. Patients completed the Neck Disability Index (NDI), Short-Form 12 (SF-12), and visual analog scale (VAS) before surgery then at 6 weeks, and 3, 6, and 12 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts.

Results: Baseline characteristics were similar between both cohorts. At baseline, there were no significant differences between cohorts in NDI (P = 0.11), SF-12 PCS (P = 0.63), SF-12 MCS (P = 0.90), and VAS neck pain (P = 0.80). There was no nerve root injury or incidental durotomy in either cohort. At 6 months after surgery, patients in the pretreated cohort reported significantly lower postoperative pain compared to the control cohort (P = 0.01). These results were durable through 1 year (P = 0.02). At 1 year, patients who were pretreated for anxiety before surgery reported significantly lower postoperative neck pain scores compared with the control cohort (P = 0.02).

Conclusion: Our study demonstrates that pretreatment of anxiety before cervical spine surgery results in a significant reduction in postoperative neck pain scores and may be a viable management strategy for patients with coexisting affective disorders and cervical spine pathology. Patients awaiting spine surgery should routinely be assessed for anxiety before surgery, and interventions to reduce and treat anxiety should be provided.

Keywords: ACDF; Affective Disorder; Anxiety; Cervical spine; Pretreatment; Surgical outcomes.