21,000-Patient Mental Health Study of Cervical Spine Fusion Patients
It’s an area where many orthopedic surgeons are reluctant to venture…mental health, that is.
Fact is, in the general population, so many with back pain, hip problems, etc., also suffer with mental health issues.
New work from intrepid researchers delves into this arena. “The Impact of Comorbid Mental Health Disorders on Complications Following Cervical Spine Surgery with Minimum 2-Year Surveillance,” is published in the March 23, 2018 edition of Spine.
The study, a retrospective analysis with nearly 21,000 patients, included patients admitted from 2009-2013 with cervical radiculopathy (CR) or cervical myelopathy (CM) who underwent cervical surgery with minimum two-year surveillance
The authors wrote, “…Mental health disorders (MHD) identified: depressive (57.8%), anxiety (28.1%), sleep (25.2%), and stress (2.9%). CR patients had greater prevalence of comorbid MHD than CM patients (p = 0.015). Two years post-operatively, all MHD patients had significantly higher rates of complications (specifically: device-related, infection), readmission for any indication, and revision surgery (all p < 0.05).”
“Nearly 25% of patients admitted for CR and CM carried comorbid mental health disorder and experienced greater rates of any complication, readmission, or revision, at minimum, two years following cervical spine surgery…”
A co-author on the study, Bassel G. Diebo, M.D. is an orthopedic surgery resident at the State University of New York Downstate Medical Center. Dr. Diebo told OTW, “My belief is that treating our patients necessitates understanding how mental health is affected and responds to spinal pathology treatment.”
“Most orthopedic surgeons believe that treating the orthopedic disease will improve both physical and mental health of the patients. This might be true as a concept, but we really need more data to support this.”
“I think the study proposes a possible association (and not causation) between mental health disorders and complications in patients undergoing surgery for thoracolumbar or cervical spinal pathologies. However, in addition to data, the study had the message of raising awareness of the importance of mental health in orthopedics and encouraging more research to better understand this relationship.”
“I think changing the practice requires extensive research including randomized trials. Therefore, following this data we promptly started our randomized trial generously funded by the Cervical Spine Research Society (CSRS) to better understand whether psychological support is effective, and recommended as a complement to surgical treatment of spinal pathologies. Simply put, even if the spinal stenosis is decompressed, the fusion is obtained, and the alignment is achieved, if the patient does not perceive improvement after surgery because of a mental health state, then there is no improvement.”
