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Correlation of mental health with physical function, pain, and disability following anterior lumbar interbody fusion

  • Original Article - Spine - Other
  • Published:
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Abstract

Background

Studies have demonstrated the influence of preoperative mental health on outcomes following spine surgery, but prior literature has not assessed the influence of mental health at time of outcome survey collection.

Methods

Patients who underwent elective anterior lumbar interbody fusion (ALIF) were identified from a prospective registry. Patient-reported outcomes (PROs) were collected preoperatively and up to 1 year postoperatively. Mental health measures studied included 12-item Short Form (SF-12) Mental Component Score (MCS) and Patient Health Questionnaire-9 (PHQ-9). Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), SF-12 Physical Component Score (PCS), visual analog scale (VAS) back and leg pain, and Oswestry Disability Index (ODI) were compared to the mental health measures by Pearson’s correlation tests.

Results

A total of 166 patients were included. SF-12 MCS demonstrated positive correlation to PROMIS-PF preoperatively (|r|= 0.379) and at 6 weeks (|r|= 0.387) (p ≤ 0.016, all). SF-12 MCS demonstrated negative correlation to VAS back at 6 months (|r|= 0.359), VAS leg at 6 weeks (|r|= 0.475) and 12 weeks (|r|= 0.422), and ODI up to 6 months postoperatively (|r|= 0.417–0.526) (p ≤ 0.037, all). PHQ-9 negatively correlated with PROMIS-PF at all periods studied (|r|= 0.425–0.587) and SF-12 PCS up to 6 months postoperatively (|r|= 0.367–0.642) (p ≤ 0.016, all). PHQ-9 positively correlated to VAS back at 6 weeks (|r|= 0.408) and 6 months (|r|= 0.411), VAS leg at 6 weeks (|r|= 0.344), and ODI up to 6 months postoperatively (|r|= 0.321–0.669) (p ≤ 0.034, all).

Conclusion

Inferior mental health correlated with inferior pain, function, and disability scores at one or more periods postoperatively. This finding was most consistent for correlation between mental health scores and disability. Optimization of mental health may positively influence outcomes, especially regarding disability, following ALIF.

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Data Availability

Data is available upon reasonable request.

Abbreviations

ALIF:

Anterior lumbar interbody fusion

ASA:

American Society of Anesthesiologists

BDI:

Beck Depression Index

BMI:

Body mass index

CCI:

Charlson Comorbidity Index

EBL:

Estimated blood loss

HNP:

Herniation of the nucleus pulposus

LOS:

Length of stay

ODI:

Oswestry Disability Index

OME:

Oral morphine equivalents

ORA:

Office of Regulatory Affairs

PHQ-9:

Patient Health Questionnaire-9

POD:

Postoperative day

PROMIS-PF:

Patient-Reported Outcomes Measurement Information System-Physical Function

PROs:

Patient-reported outcomes

SD:

Standard deviation

SF-12 MCS:

12-Item Short Form Mental Component Score

SF-12 PCS:

12-Item Short Form Physical Component Score

VAS:

Visual analog scale

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA

    Timothy J. Hartman, James W. Nie, Keith R. MacGregor, Omolabake O. Oyetayo, Eileen Zheng & Kern Singh

Authors
  1. Timothy J. Hartman
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  2. James W. Nie
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  4. Omolabake O. Oyetayo
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  6. Kern Singh
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Contributions

Timothy J. Hartman, MD: conceptualization, methodology, visualization, formal analysis, software, investigation, writing – original draft, writing – review and editing.

James W. Nie, BS: conceptualization, methodology, visualization, formal analysis, software, investigation, writing – original draft, writing – review and editing.

Eileen Zheng, BS: project administration, data curation, investigation, writing – review and editing.

Keith R. MacGregor, BS: project administration, data curation, investigation, writing – review and editing.

Omolabake O. Oyetayo, BS: project administration, data curation, investigation, writing – review and editing.

Kern Singh, MD: conceptualization, methodology, supervision, resources, investigation, writing – review and editing.

Corresponding author

Correspondence to Kern Singh.

Ethics declarations

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board (IRB) of Rush University Medical Center (ORA #14051301).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Competing interests

Kern Singh, MD, receives royalties from Zimmer Biomet, Stryker, RTI Surgical, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, and Slack Publishing. Kern Singh, MD, owns stock in Avaz Surgical LLC and Vital 5 LLC. Kern Singh, MD, holds a consulting position with Zimmer Biomet and K2M. Kern Singh, MD, holds board membership with Vital 5 LLC. Kern Singh, MD, is on the editorial board of Contemporary Spine Surgery. Kern Singh, MD, received a research grant from the Cervical Spine Research Society.

Kern Singh, MD, holds board membership with TDi LLC and Minimally Invasive Spine Study Group and receives no compensation as board member. Kern Singh, MD, is on the editorial board of Orthopedics Today and Vertebral Columns and receives no compensation as member of the editorial board. Kern Singh, MD, is on the board of directors of Cervical Spine Research Society, International Society for the Advancements of Spine Surgery, and American Academy of Orthopaedic Surgeons and receives no compensation as member of the board of directors.

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Comments

Hartman et al. have presented an interesting study on the influence of preoperative mental health on outcomes following anterior lumbar interbody fusion. Thereby, inferior mental health seems to correlate well with inferior results regarding pain, function, and disability postoperatively. This finding was most consistent for correlation between mental health scores and disability. Conversely, it can be assumed that the spinal complaints and symptoms themselves and postoperative outcomes on the other hand might influence mental health before and after surgery. Although exclusively the results following anterior lumbar interbody fusion have been examined here, it also can be assumed that optimization of mental health may positively influence clinical outcomes also after alternative procedures such as transforaminal, posterior, or extreme lateral lumbar interbody fusion. I congratulate the authors on this relevant article in which the complex relationship between mental and physical health in spine surgery was further elucidated.

Markus Florian Oertel

Zurich, Switzerland

This article is part of the Topical Collection on Spine—Other

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Hartman, T.J., Nie, J.W., MacGregor, K.R. et al. Correlation of mental health with physical function, pain, and disability following anterior lumbar interbody fusion. Acta Neurochir 165, 341–349 (2023). https://doi.org/10.1007/s00701-022-05459-5

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