Depression is associated with the long-term outcome of lumbar spinal stenosis surgery: a 10-year follow-up study

Iina Tuomainen; Maarit Pakarinen; Timo Aalto; Sanna Sinikallio; Heikki Kröger; Heimo Viinamäki; Olavi Airaksinen

doi:10.1016/j.spinee.2017.08.228

Depression is associated with the long-term outcome of lumbar spinal stenosis surgery: a 10-year follow-up study

Spine J. 2018 Mar;18(3):458-463. doi: 10.1016/j.spinee.2017.08.228. Epub 2017 Aug 16.

Authors

Iina Tuomainen¹, Maarit Pakarinen², Timo Aalto³, Sanna Sinikallio⁴, Heikki Kröger⁵, Heimo Viinamäki², Olavi Airaksinen⁶

Affiliations

¹ Department of Rehabilitation, Kuopio University Hospital, Building 6, 1st floor, PL 100, FI-70029 KYS, Finland. Electronic address: iinatuo@student.uef.fi.
² Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Building 5, 7th floor, PO Box 1777, FI-70211 Kuopio, Finland.
³ Medical Center Ikioma, Porrassalmenkatu 21, 50100 Mikkeli, Finland.
⁴ School of Educational Sciences and Psychology, University of Eastern Finland, PO Box 111, 80101 Joensuu, Finland.
⁵ Department of Orthopaedics and Traumatology, Kuopio University Hospital and Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland.
⁶ Department of Rehabilitation, Kuopio University Hospital, Building 6, 1st floor, PL 100, FI-70029 KYS, Finland.

PMID: 28822826
DOI: 10.1016/j.spinee.2017.08.228

Abstract

Background context: Depression is associated with greater postoperative disability in patients with lumbar spinal stenosis (LSS). No previous studies have reported the association in a 10-year follow-up.

Purpose: To evaluate the association between preoperative and postoperative depressive symptoms and the surgical outcome among patients with LSS in a 10-year follow-up. In addition, we examined the effects of the depressive burden on the surgical outcome.

Design: A prospective observational follow-up study.

Patient sample: A total of 102 patients with LSS underwent decompressive surgery, and 72 of the original sample participated in the 10-year follow-up study.

Outcome measures: Self-report measures: the Oswestry Disability Index (ODI) and visual analog scale (VAS).

Methods: Data were collected using a questionnaire that was administered seven times during the study period. Depressive symptoms were measured with the Beck Depressive Inventory (BDI). The depressive burden was calculated by summing the preoperative and all follow-up BDI scores. Statistical analysis included cross-sectional group comparisons and linear mixed models. The authors report no conflicts of interest related to this work.

Results: The high depressive burden group had a poorer outcome for pain, disability, and the walking distance at the 10-year follow-up. In linear mixed models, a higher preoperative BDI score associated with higher disability. Furthermore, higher postoperative BDI scores and the depressive burden were associated with higher disability and pain in the 10-year follow-up.

Conclusions: Patients with LSS with even slightly elevated depressive symptoms have an increased risk of postoperative pain and disability in a 10-year follow-up. To improve the surgical outcome among these patients, screening for depression both preoperatively and during the rehabilitation following surgery is important.

Keywords: Depression; Disability; Long-term; Lumbar spinal stenosis; Subthreshold depression; Surgery.

MeSH terms

Adult
Aged
Decompression, Surgical / adverse effects*
Depression / epidemiology*
Female
Humans
Lumbar Vertebrae / surgery
Male
Middle Aged
Postoperative Complications / epidemiology*
Postoperative Complications / psychology
Spinal Stenosis / epidemiology
Spinal Stenosis / psychology
Spinal Stenosis / surgery*