The Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of a Combined Prospective Dataset

Lindsay Tetreault, Narihito Nagoshi, Hiroaki Nakashima, Anoushka Singh, Branko Kopjar, Paul Arnold, Michael G. Fehlings

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

STUDY DESIGN.: Analysis of a combined prospective dataset. OBJECTIVE.: To compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA.: Psychiatric co-morbidities, including depression, have been associated with worse clinical outcomes following lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM. METHODS.: Four hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6-, 12- and 24-months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short- Form 36v2 (SF-36) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24-months between patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors. RESULTS.: Ninety-seven patients (24.19%) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98%) with these psychiatric disorders than males (34.02%) (p?<?0.0001). Patients with psychiatric co-morbidities were more likely to have cardiovascular (p?=?0.0177), respiratory (p?<?0.0001), gastrointestinal (p?<?0.0001), rheumatologic (p?=?0.0109) and neurologic (p?=?0.0309) disorders. At 24-months following surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI and SF-36 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24-months between patients in each group. Improvement in NDI, SF-36 PCS and MCS, however, were smaller in patients with depression or bipolar disorder than those without. CONCLUSIONS.: Patients with depression or bipolar disorder have smaller functional and quality of life improvements following surgery compared to patients without psychiatric co-morbidities

Original languageEnglish
JournalSpine
DOIs
Publication statusAccepted/In press - 2016 Jul 7

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Spinal Cord Diseases
Bipolar Disorder
Quality of Life
Depression
Psychiatry
Orthopedics
Preexisting Condition Coverage
Neck
Morbidity
Datasets
North America
Quality Improvement
Health Surveys
Nervous System
Spine

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

The Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy : Analysis of a Combined Prospective Dataset. / Tetreault, Lindsay; Nagoshi, Narihito; Nakashima, Hiroaki; Singh, Anoushka; Kopjar, Branko; Arnold, Paul; Fehlings, Michael G.

In: Spine, 07.07.2016.

Research output: Contribution to journalArticle

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title = "The Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of a Combined Prospective Dataset",
abstract = "STUDY DESIGN.: Analysis of a combined prospective dataset. OBJECTIVE.: To compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA.: Psychiatric co-morbidities, including depression, have been associated with worse clinical outcomes following lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM. METHODS.: Four hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6-, 12- and 24-months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short- Form 36v2 (SF-36) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24-months between patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors. RESULTS.: Ninety-seven patients (24.19{\%}) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98{\%}) with these psychiatric disorders than males (34.02{\%}) (p?<?0.0001). Patients with psychiatric co-morbidities were more likely to have cardiovascular (p?=?0.0177), respiratory (p?<?0.0001), gastrointestinal (p?<?0.0001), rheumatologic (p?=?0.0109) and neurologic (p?=?0.0309) disorders. At 24-months following surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI and SF-36 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24-months between patients in each group. Improvement in NDI, SF-36 PCS and MCS, however, were smaller in patients with depression or bipolar disorder than those without. CONCLUSIONS.: Patients with depression or bipolar disorder have smaller functional and quality of life improvements following surgery compared to patients without psychiatric co-morbidities",
author = "Lindsay Tetreault and Narihito Nagoshi and Hiroaki Nakashima and Anoushka Singh and Branko Kopjar and Paul Arnold and Fehlings, {Michael G.}",
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T1 - The Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy

T2 - Analysis of a Combined Prospective Dataset

AU - Tetreault, Lindsay

AU - Nagoshi, Narihito

AU - Nakashima, Hiroaki

AU - Singh, Anoushka

AU - Kopjar, Branko

AU - Arnold, Paul

AU - Fehlings, Michael G.

PY - 2016/7/7

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N2 - STUDY DESIGN.: Analysis of a combined prospective dataset. OBJECTIVE.: To compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA.: Psychiatric co-morbidities, including depression, have been associated with worse clinical outcomes following lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM. METHODS.: Four hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6-, 12- and 24-months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short- Form 36v2 (SF-36) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24-months between patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors. RESULTS.: Ninety-seven patients (24.19%) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98%) with these psychiatric disorders than males (34.02%) (p?<?0.0001). Patients with psychiatric co-morbidities were more likely to have cardiovascular (p?=?0.0177), respiratory (p?<?0.0001), gastrointestinal (p?<?0.0001), rheumatologic (p?=?0.0109) and neurologic (p?=?0.0309) disorders. At 24-months following surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI and SF-36 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24-months between patients in each group. Improvement in NDI, SF-36 PCS and MCS, however, were smaller in patients with depression or bipolar disorder than those without. CONCLUSIONS.: Patients with depression or bipolar disorder have smaller functional and quality of life improvements following surgery compared to patients without psychiatric co-morbidities

AB - STUDY DESIGN.: Analysis of a combined prospective dataset. OBJECTIVE.: To compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA.: Psychiatric co-morbidities, including depression, have been associated with worse clinical outcomes following lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM. METHODS.: Four hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6-, 12- and 24-months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short- Form 36v2 (SF-36) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24-months between patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors. RESULTS.: Ninety-seven patients (24.19%) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98%) with these psychiatric disorders than males (34.02%) (p?<?0.0001). Patients with psychiatric co-morbidities were more likely to have cardiovascular (p?=?0.0177), respiratory (p?<?0.0001), gastrointestinal (p?<?0.0001), rheumatologic (p?=?0.0109) and neurologic (p?=?0.0309) disorders. At 24-months following surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI and SF-36 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24-months between patients in each group. Improvement in NDI, SF-36 PCS and MCS, however, were smaller in patients with depression or bipolar disorder than those without. CONCLUSIONS.: Patients with depression or bipolar disorder have smaller functional and quality of life improvements following surgery compared to patients without psychiatric co-morbidities

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