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Depression as a prognostic factor for lumbar spinal stenosis outcomes: a systematic review

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Abstract

Purpose

Lumbar spinal stenosis (LSS) is associated with increased levels of psychological distress, including depression; however, the prognostic value of depression remains unclear. The purpose of this systematic review was to synthesize the evidence on the prognostic value of depression for a range of outcomes in patients with LSS.

Methods

Inclusion criteria were prospective cohort studies that investigated depression in patients diagnosed with LSS. Searches were conducted in 7 databases. Critical appraisal, data extraction, and judgement of cumulative evidence were conducted independently by two reviewers. A meta-analysis was not conducted due to a lack of unique cohorts for each outcome, varying follow-up times, and differences in measurements for both prognostic factors and outcomes.

Results

Twenty-three articles were included. There was evidence for an association between preoperative depression and postoperative disability and symptom severity outcomes for patients with LSS. Odds ratios ranged from 1.15 to 2.94 for postoperative disability and 1.16–1.20 for symptom severity at various follow-up times. Using GRADE, evidence supporting depression as a prognostic factor for these LSS outcomes was deemed to be of moderate quality. Similarly strong evidence suggested depressive symptoms are of no prognostic value for postoperative walking capacity.

Conclusion

Depression appears to have small to moderate prognostic value for LSS outcomes, with the strongest evidence for postoperative disability and symptom severity. The prognostic value of depression for LSS outcomes should be further explored using standardized measures in additional cohorts, including patients managing their condition conservatively, who have been neglected in related research.

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References

  1. Genevay S, Atlas SJ (2010) Lumbar spinal stenosis. Best Pract Res Clin Rheumatol 24(2):253–265. https://doi.org/10.1016/j.berh.2009.11.001

    Article  PubMed  PubMed Central  Google Scholar 

  2. Group E (2021) Treatment of degenerative lumbar spinal stenosis: Summary. Accessed 28 May 2021, from https://www.ncbi.nlm.nih.gov/books/NBK11855/

  3. Kalichman L, Cole R, Kim DH, Li L, Suri P, Guermazi A, Hunter DJ (2009) Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine J Off J N Am Spine Soc 9(7):545–550. https://doi.org/10.1016/j.spinee.2009.03.005

    Article  Google Scholar 

  4. McKillop A, Carroll L, Battié M (2014) Depression as a prognostic factor of lumbar spinal stenosis: a systematic review. Spine J 14(5):837–846. https://doi.org/10.1016/j.spinee.2013.09.052

    Article  PubMed  Google Scholar 

  5. Edwards T, Lavallee D, Bauer Z, Comstock B, Jarvik J, Patrick D et al (2015) Problem areas identified as important to older adults with lumbar spinal stenosis. Spine J 15(7):1636–1644. https://doi.org/10.1016/j.spinee.2015.03.008

    Article  PubMed  Google Scholar 

  6. Meyer T, Cooper J, Raspe H (2007) Disabling low back pain and depressive symptoms in the community-dwelling elderly: a prospective study. Spine 32(21):2380–2386. https://doi.org/10.1097/BRS.0b013e3181557955

    Article  PubMed  Google Scholar 

  7. Slover J, Abdu W, Hanscom B, Weinstein J (2006) The impact of comorbidities on the change in short-form 36 and oswestry scores following lumbar spine surgery. Spine 31(17):1974–1980. https://doi.org/10.1097/01.brs.0000229252.30903.b9

    Article  PubMed  Google Scholar 

  8. Pinheiro M, Ferreira M, Refshauge K, Maher C, Ordoñana J, Andrade T et al (2016) Symptoms of depression as a prognostic factor for low back pain: a systematic review. Spine J 16(1):105–116. https://doi.org/10.1016/j.spinee.2015.10.037

    Article  PubMed  Google Scholar 

  9. Pincus T, Burton A, Vogel S, Field A (2002) A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 27(5):E109–E120. https://doi.org/10.1097/00007632-200203010-00017

    Article  PubMed  Google Scholar 

  10. Welch C, Czerwinski D, Ghimire B, Bertsimas D (2009) Depression and costs of health care. Psychosomatics 50(4):392–401

    Article  PubMed  Google Scholar 

  11. Aalto T, Malmivaara A, Kovacs F, Herno A, Alen M, Salmi L et al (2006) Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis. Spine 31(18):E648–E663. https://doi.org/10.1097/01.brs.0000231727.88477.da

    Article  PubMed  Google Scholar 

  12. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. https://doi.org/10.1136/bmj.b2700

    Article  PubMed  PubMed Central  Google Scholar 

  13. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) (2021) Cochrane Handbook for Systematic Reviews of Interventions version 6.2. Cochrane, 2021. www.training.cochrane.org/handbook

  14. Grooten W, Tseli E, Äng B, Boersma K, Stålnacke B, Gerdle B, Enthoven P (2019) Elaborating on the assessment of the risk of bias in prognostic studies in pain rehabilitation using QUIPS—aspects of interrater agreement. Diagn Progn Res. https://doi.org/10.1186/s41512-019-0050-0

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hayden J, van der Windt D, Cartwright J, Côté P, Bombardier C (2013) Assessing bias in studies of prognostic factors. Ann Intern Med 158(4):280. https://doi.org/10.7326/0003-4819-158-4-201302190-00009

    Article  PubMed  Google Scholar 

  16. Huguet A, Hayden J, Stinson J, McGrath P, Chambers C, Tougas M, Wozney L (2013) Judging the quality of evidence in reviews of prognostic factor research: adapting the GRADE framework. Syst Rev. https://doi.org/10.1186/2046-4053-2-71

    Article  PubMed  PubMed Central  Google Scholar 

  17. Murad M, Mustafa R, Schünemann H, Sultan S, Santesso N (2017) Rating the certainty in evidence in the absence of a single estimate of effect. Evid Based Med 22(3):85–87. https://doi.org/10.1136/ebmed-2017-110668

    Article  PubMed  PubMed Central  Google Scholar 

  18. Popay J et al. (2006) Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme

  19. Dobran M, Nasi D, Gladi M, Marinelli M, Mancini F, Iacoangeli M, Scerrati M (2018) Clinical and psychological outcome after surgery for lumbar spinal stenosis: a prospective observational study with analysis of prognostic factors. Neurol Neurochir Pol 52(1):70–74. https://doi.org/10.1016/j.pjnns.2017.12.002

    Article  PubMed  Google Scholar 

  20. Sinikallio S, Aalto T, Airaksinen O, Herno A, Kröger H, Savolainen S et al (2007) Depression is associated with poorer outcome of lumbar spinal stenosis surgery. Eur Spine J 16(7):905–912. https://doi.org/10.1007/s00586-007-0349-3

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sinikallio S, Aalto T, Airaksinen O, Herno A, Kröger H, Savolainen S et al (2007) Lumbar spinal stenosis patients are satisfied with short-term results of surgery—younger age, symptom severity, disability and depression decrease satisfaction. Disabil Rehabil 29(7):537–544. https://doi.org/10.1080/09638280600902646

    Article  PubMed  Google Scholar 

  22. Sinikallio S, Aalto T, Koivumaa-Honkanen H, Airaksinen O, Herno A, Kröger H, Viinamäki H (2009) Life dissatisfaction is associated with a poorer surgery outcome and depression among lumbar spinal stenosis patients: a 2-year prospective study. Eur Spine J 18(8):1187–1193. https://doi.org/10.1007/s00586-009-0955-3

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sinikallio S, Airaksinen O, Aalto T, Lehto S, Kröger H, Viinamäki H (2010) Coexistence of pain and depression predicts poor 2-year surgery outcome among lumbar spinal stenosis patients. Nord J Psychiatry 64(6):391–396. https://doi.org/10.3109/08039481003759193

    Article  PubMed  Google Scholar 

  24. Sinikallio S, Aalto T, Airaksinen O, Lehto S, Kröger H, Viinamäki H (2011) Depression is associated with a poorer outcome of lumbar spinal stenosis surgery. Spine 36(8):677–682. https://doi.org/10.1097/brs.0b013e3181dcaf4a

    Article  PubMed  Google Scholar 

  25. Sinikallio S, Lehto S, Aalto T, Airaksinen O, Viinamäki H (2011) Low sense of coherence interferes with lumbar spinal stenosis patients’ postoperative recovery: A prospective one-year follow-up study. J Health Psychol 16(5):783–793. https://doi.org/10.1177/1359105310390723

    Article  PubMed  Google Scholar 

  26. Sinikallio S, Lehto S, Aalto T, Airaksinen O, Kröger H, Viinamäki H (2010) Depressive symptoms during rehabilitation period predict poor outcome of lumbar spinal stenosis surgery: a two-year perspective. BMC Musculoskelet Disord. https://doi.org/10.1186/1471-2474-11-152

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sinikallio S, Aalto T, Airaksinen O, Herno A, Kröger H, Viinamäki H (2009) Depressive burden in the preoperative and early recovery phase predicts poorer surgery outcome among lumbar spinal stenosis patients. Spine 34(23):2573–2578. https://doi.org/10.1097/brs.0b013e3181b317bd

    Article  PubMed  Google Scholar 

  28. Sinikallio S, Aalto T, Lehto S, Airaksinen O, Herno A, Kröger H, Viinamäki H (2010) Depressive symptoms predict postoperative disability among patients with lumbar spinal stenosis: a two-year prospective study comparing two age groups. Disabil Rehabil 32(6):462–468. https://doi.org/10.3109/09638280903171477

    Article  PubMed  Google Scholar 

  29. Adogwa O, Carr K, Fatemi P, Verla T, Gazcon G, Gottfried O et al (2014) Psychosocial factors and surgical outcomes. Spine 39(19):1614–1619. https://doi.org/10.1097/brs.0000000000000474

    Article  PubMed  Google Scholar 

  30. Katz J, Lipson S, Brick G, Grobler L, Weinstein J, Fossel A et al (1995) Clinical correlates of patient satisfaction after laminectomy for degenerative lumbar spinal stenosis. Spine 20(10):1155–1159. https://doi.org/10.1097/00007632-199505150-00008

    Article  PubMed  CAS  Google Scholar 

  31. Tuomainen I, Pakarinen M, Aalto T, Sinikallio S, Kröger H, Viinamäki H, Airaksinen O (2018) Depression is associated with the long-term outcome of lumbar spinal stenosis surgery: a 10-year follow-up study. Spine J 18(3):458–463. https://doi.org/10.1016/j.spinee.2017.08.228

    Article  PubMed  Google Scholar 

  32. Wada T, Tanishima S, Kitsuda Y, Osaki M, Nagashima H, Hagino H (2020) Preoperative low muscle mass is a predictor of falls within 12 months of surgery in patients with lumbar spinal stenosis. BMC Geriatr 20(1):1–8. https://doi.org/10.1186/s12877-020-01915-y

    Article  Google Scholar 

  33. Pakarinen M, Vanhanen S, Sinikallio S, Aalto T, Lehto S, Airaksinen O, Viinamäki H (2014) Depressive burden is associated with a poorer surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study. Spine J 14(10):2392–2396. https://doi.org/10.1016/j.spinee.2014.01.047

    Article  PubMed  Google Scholar 

  34. Herron L, Turner J, Clancy S, Weiner P (1986) The differential utility of the minnesota multiphasic personality inventory. Spine 11(8):847–850. https://doi.org/10.1097/00007632-198610000-00022

    Article  PubMed  CAS  Google Scholar 

  35. Urban-Baeza A, Zárate-Kalfópulos B, Romero-Vargas S, Obil-Chavarría C, Brenes-Rojas L, Reyes-Sánchez A (2015) Influence of depression symptoms on patient expectations and clinical outcomes in the surgical management of spinal stenosis. J Neurosurg Spine 22(1):75–79. https://doi.org/10.3171/2014.10.spine131106

    Article  PubMed  Google Scholar 

  36. Kim J, Lee S, Kim T (2020) Improvement of sleep quality after treatment in patients with lumbar spinal stenosis: a prospective comparative study between conservative versus surgical treatment. Sci Rep 10(1):14135. https://doi.org/10.1038/s41598-020-71145-0

    Article  ADS  PubMed  PubMed Central  CAS  Google Scholar 

  37. Pakarinen M, Tuomainen I, Koivumaa-Honkanen H, Sinikallio S, Lehto S, Airaksinen O et al (2016) Life dissatisfaction is associated with depression and poorer surgical outcomes among lumbar spinal stenosis patients: a 10-year follow-up study. Int J Rehabil Res 39(4):291–295. https://doi.org/10.1097/mrr.0000000000000182

    Article  PubMed  Google Scholar 

  38. Pakarinen M, Sinikallio S, Koivumaa-Honkanen H, Aalto T, Airaksinen O, Lehto S, Viinamäki H (2017) Low sense of coherence during postoperative recovery is associated with a poorer lumbar spinal stenosis—surgical outcome: a 5-year follow-up study. J Health Psychol 22(3):347–355. https://doi.org/10.1177/1359105315603471

    Article  PubMed  Google Scholar 

  39. Adogwa O, Verla T, Thompson P, Penumaka A, Kudyba K, Johnson K et al (2014) Affective disorders influence clinical outcomes after revision lumbar surgery in elderly patients with symptomatic adjacent-segment disease, recurrent stenosis, or pseudarthrosis. J Neurosurg Spine 21(2):153–159. https://doi.org/10.3171/2014.4.spine12668

    Article  PubMed  Google Scholar 

  40. Katz J, Stucki G, Lipson S, Fossel A, Grobler L, Weinstein J (1999) Predictors of surgical outcome in degenerative lumbar spinal stenosis. Spine 24(21):2229. https://doi.org/10.1097/00007632-199911010-00010

    Article  PubMed  CAS  Google Scholar 

  41. Iversen MD, Daltroy LH, Fossel AH, Katz JN (1998) The prognostic importance of patient pre-operative expectations of surgery for lumbar spinal stenosis. Patient Educ Couns 1998(34):169–178

    Article  Google Scholar 

  42. Stucki G, Daltroy L, Liang M, Lipson S, Fossel A, Katz J (1996) Measurement properties of a self-administered outcome measure in lumbar spinal. Spine 21:796–803

    Article  PubMed  CAS  Google Scholar 

  43. Szumilas M (2010) Explaining odds ratios journal of the canadian academy of child and adolescent psychiatry. J de l’Academie canadienne de psychiatrie de l’enfant et de l’adolescent. 19(3):227–229

    Google Scholar 

  44. Mental health: Culture, race and ethnicity (2001) U.S. Dept. of Health and Human Services, Public Health Service, Office of the Surgeon General

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Acknowledgements

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Authors and Affiliations

  1. School of Physical Therapy, Western University, London, ON, Canada

    Ariel Morales & Alaa El Chamaa

  2. Schulich School of Medicine & Dentistry, Western University, London, ON, Canada

    Swati Mehta

  3. School of Physical Therapy, Faculty of Health Sciences and Western’s Bone & Joint Institute, Western University, 1201 Western Road, London, ON, N6A 1H1, Canada

    Alison Rushton & Michele C. Battié

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Correspondence to Michele C. Battié.

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Morales, A., El Chamaa, A., Mehta, S. et al. Depression as a prognostic factor for lumbar spinal stenosis outcomes: a systematic review. Eur Spine J 33, 851–871 (2024). https://doi.org/10.1007/s00586-023-08002-x

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