Impact of Early Depressive Burden on Patient-Reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Jacob C Wolf; Fatima N Anwar; Andrea M Roca; Alexandra C Loya; Srinath S Medakkar; Aayush Kaul; Ishan Khosla; Timothy J Hartman; James W Nie; Keith R MacGregor; Omolabake O Oyetayo; Eileen Zheng; Vincent P Federico; Arash J Sayari; Gregory D Lopez; Kern Singh

doi:10.1097/BSD.0000000000001653

Impact of Early Depressive Burden on Patient-Reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Clin Spine Surg. 2024 Jun 27. doi: 10.1097/BSD.0000000000001653. Online ahead of print.

Authors

Jacob C Wolf¹, Fatima N Anwar², Andrea M Roca², Alexandra C Loya², Srinath S Medakkar², Aayush Kaul¹, Ishan Khosla², Timothy J Hartman², James W Nie², Keith R MacGregor², Omolabake O Oyetayo², Eileen Zheng², Vincent P Federico², Arash J Sayari², Gregory D Lopez², Kern Singh²

Affiliations

¹ Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago.
² Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

PMID: 38934500
DOI: 10.1097/BSD.0000000000001653

Abstract

Study design: Retrospective review.

Objective: To evaluate mental health influence on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) patients.

Summary of background data: Poor mental health has been postulated to indicate inferior patient perceptions of surgical outcomes in spine literature. Few studies have assessed mental health as a dynamic metric throughout the perioperative period.

Methods: A single-surgeon database was retrospectively searched for patients who underwent primary, elective MIS-TLIF for degenerative or isthmic spondylolisthesis. Summative depressive burden (SDB) was defined by the sum of preoperative and 6-week postoperative 9-item Patient Health Questionnaire (PHQ-9), with Lesser Burden (LB, SDB<10) and Greater Burden (GB, SDB≥10) cohorts. Patient-reported outcomes measures (PROMs) were compared preoperatively, at 6 weeks, and at final postoperative follow-up (11.4±10.9 mo), using Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Oswestry disability index (ODI), visual analog scale-back (VAS-B), VAS-leg (VAS-L), and PHQ-9. Improvements at 6-week (∆PROM-6W), final follow-up (∆PROM-FF), and minimum clinically important difference (MCID) achievement were compared.

Results: The GB cohort consisted of 44 of 105 patients. Demographic variations included older age, higher Charlson comorbidity index, increased hypertension prevalence, and private insurance in the LB cohort (P≤0.018). The LB cohort demonstrated better baseline and 6-week PROMIS-PF/ODI/VAS-L (P≤0.032) and better final PROMIS-PF/ODI/VAS-L/PHQ-9 (P≤0.031). Both cohorts improved in all PROMs at 6 weeks and final follow-up (P≤0.029), except for PROMIS-PF at 6 weeks in the GB cohort. ∆PROM-6W, ∆PROM-FF, and MCID achievement rate for PHQ-9 were greater in the GB cohort (P≤0.001).

Conclusion: On average, patients undergoing MIS-TLIF for degenerative or isthmic spondylolisthesis improved in all PROMs by final follow-up. Patients with GB suffered inferior perceptions of physical function, disability, and leg pain. MCID rates in mental health were higher for GB cohort. Surgeons are encouraged to adopt a compassionate understanding of depressive burden and educate the patient on possible consequential postoperative outcomes.