gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Influence of psychiatric comorbidities on clinical outcome before and after elective spine surgery – A prospective observational study

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  • Ehab Shiban - Neurochirurgische Klinik, Technische Universität München
  • Youssef Shiban - Klinische Psychologie und Psychotherapie, Universitätsklinikum Regensburg
  • Corinna Kapp - Neurochirurgische Klinik, Technische Universität München
  • Leila Sahinovic - Neurochirurgische Klinik, Technische Universität München
  • Michael Eisenburger - Neurochirurgische Klinik, Technische Universität München
  • Verena Kammermeier - Neurochirurgische Klinik, Technische Universität München
  • Andreas Mühlberger - Klinische Psychologie und Psychotherapie, Universitätsklinikum Regensburg
  • Jens Lehmberg - Neurochirurgische Klinik, Technische Universität München
  • Bernhard Meyer - Neurochirurgische Klinik, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMI.01.02

doi: 10.3205/15dgnc250, urn:nbn:de:0183-15dgnc2507

Published: June 2, 2015

© 2015 Shiban et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: It is widely accepted that psychiatric comorbidities have a negative influence on health-related quality of life and long-term outcomes following spine surgery. However, most published data is restricted to postoperative measurements and data from preoperative settings is lacking. Aim of this study was to assess the incidence and influence of psychiatric comorbidities on clinical outcome in patients undergoing elective spine surgery.

Method: A prospective study of patients undergoing elective spine surgery was performed. Evaluation for depression (ADS-K score) and anxiety (STAI-S, STAI-T and ASI-3 scores) before surgery and at three months follow-up were done. In addition SF36 physical composite score (PCS), Oswestry Disability Index (ODI) and pain visual analog scale (VAS) were completed preoperatively and 3 months postoperatively. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined.

Results: 104 patients met all inclusion criteria. 56 patients were male (53.8%); mean age was 59.7 years. Most patients were married or in a steady relationship (83.5%). Abnormal STAI-S, STAI-T and ASI-3 anxiety scores were encountered preoperatively in 49%, 33.6% and 11.5% of cases but resolved in 19.2%, 17.3% and 4.8% of cases at 3 months follow-up. 18.3%, 12.5%, 2.9% reported abnormal STAI-S, STAI-T and ASI-3 anxiety scores only following surgery, respectively. Abnormal ADK-S score were seen in 25% of cases before surgery and resolved in 16% of cases at 3 months follow-up. 5.8% of patients showed abnormal ASD-K scores only following surgery. Patients with an anxiety disorder at follow-up had a worse clinical outcome compared to their counterparts (ODI: 29.95 vs 17.91, P=0.006; VAS pain: 4.5 vs 2.8, P=0.003, PCS: 34.6 vs 41.6, P=0.003). Pathologic depression scores also had a negative influence on most clinical outcome measurements (ODI: 40.3 vs 21.3, P=0.001; VAS pain: 5.6 vs 3.3, P=0.003, PCS: 33.6 vs. 38.5, P=0,191).

Conclusions: The incidence of depression and anxiety disorders in patients undergoing elective spine surgery is very high. This was also associated with unfavourable outcome. Most cases of depression and anxiety were present prior to surgery. More patients are needed in order to assess the possibility of preoperative screening for such comorbidities as many of the patients psychiatric problems resolved after surgery.

Note: Ehab Shiban and Youssef Shiban contributed equally.