Poor Mental Health Irrelevant to Degree of Postop Gains?

A team from the Department of Orthopaedic Surgery at Singapore General Hospital examined 104 patients who had single-level anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy and their preoperative mental health and found that the degree of post op improvements were largely NOT correlated with mental health.

Their work, “Poor Baseline Mental Health Does Not Influence Improvement in Patient-reported Outcomes, Satisfaction, and Return to Work Two Years After Single-level Anterior Cervical Discectomy and Fusion,” was published in the June 15, 2019 edition of Spine.

Lead author Graham Goh, MBBS, MRCS (Edin) told OTW, “Anterior cervical discectomy and fusion (ACDF) is a successful procedure for the treatment of degenerative cervical myelopathy. However, we noted in follow-up visits that a subgroup of patients did not experience significant improvements in pain and disability after surgery.”

“Using the wealth of data on spine surgery outcomes that we had collected over more than 10 years, we began identifying potential preoperative risk factors for poorer outcome. Depression and anxiety are known predictors for the onset and severity of disabling neck and back pain, hence we had concerns that a patient’s preoperative mental health status would influence his/her postoperative outcome after cervical spine surgery.”

Co-author Lincoln Liow, MBBS, DWD (CAW), MRCS (Edin), MMed (Ortho) told OTW, “Patients with poor mental health had greater residual neck pain and disability postoperatively. However, the degree of improvement in outcome scores was comparable between those who had poor mental health and those who did not.”

“Both groups experienced a clinically significant improvement and were equally satisfied after ACDF. Moreover, patients with psychological distress preoperatively had a greater improvement in mental health postoperatively.”

“Screening for psychological disorders using simple mental health assessment tools widely available could easily become part of the preoperative workup for patients in every orthopaedic practice, including surgeons performing ACDF. Many spine centres have already incorporated psychological screening in their spine surgery programs.”

“The impact of any mental disability on perceived outcome can be discussed with the patient preoperatively. If an organic psychiatric cause is detected, the patient could undergo specific psychological preoperative treatment to optimize results after ACDF. Customized exercise programmes, behavioural support and modification of their expectations of ACDF could simultaneously help to improve satisfaction, self-efficacy and the mood of the patient.”

Co-author John Chen, MBBS (NUI), BAO, LRCSI FRCS (Edin),director of the spine service at Singapore General Hospital, said, “ACDF reduced the prevalence of psychological distress in our cohort, likely because of a reduction in physical limitations achieved after surgery, as evident from their improved functional and quality of life indices.”

“It is possible that lower preoperative mental health was driven by spinal disability. While patients with poorer preoperative mental health had relatively poorer function, greater pain and worse neurogenic symptoms pre- and postoperatively, these patients experienced a clinically significant improvement in all outcome scores.”

“The results of this study show that mental health improves in patients with degenerative cervical myelopathy who underwent ACDF, together with a reduction in pain and disability. Surgical treatment for myelopathy may work synergistically with mental health treatments to improve the quality of life to a greater extent than might be seen with either isolated intervention.”