Skip to main content
SpringerLink
Log in

Poor patient-reported mental health correlates with inferior patient-reported outcome measures following cervical disc replacement

  • Original Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Purpose

This study aims to assess the correlation between the patient-reported mental health and the self-reported outcome measures (PROMs) physical function, pain, and disability at different time points following disc replacement (CDR).

Methods

A single-surgeon registry was searched for patients who had undergone CDR, excluding those with indication for infection, cancer, or trauma. One hundred fifty-one patients were included. PROMs were collected preoperatively as well as 6 weeks, 3 months, 6 months, and 1 year postoperatively. Mental health measures evaluated included 12-Item Short Form (SF-12), Mental Component Score (MCS), and Patient Health Questionnaire-9 (PHQ-9) which were individually assessed via Pearson’s correlation tests in relation to Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), SF-12 Physical Component Score (PCS), visual analog scale (VAS) neck and arm pain, and Neck Disability Index (NDI).

Results

SF-12 MCS positively correlated with PROMIS-PF (range: r = 0.369–0.614) and SF-12 PCS (range: r = 0.208–0.585) with significance found at two or more time points for each (p ≤ 0.009, all). SF-12 MCS negatively correlated with VAS neck (range: r = − 0.259 to − 0.464), VAS arm (range: r = − 0.281 to − 0.567), and NDI (range: r = − 0.474 to − 831) with significance found at three or more time points (p ≤ 0.028, all). PHQ-9 significantly negatively correlated with PROMIS-PF (range: r = − 0.457 to − 0.732) and SF-12 PCS (range: r = − 0.332 to − 0.629) at all time points (p ≤ 0.013, all). PHQ-9 positively correlated with VAS neck (range: r = 0.351–0.711), VAS arm (range: r = 0.239–0.572), and NDI (range: r = 0.602–0.837) at four or more periods (p ≤ 0.032, all).

Conclusion

Patients undergoing CDR who reported lower mental health scores via either SF-12 MCS or PHQ-9 were associated with increased perception of pain and disability. Disability level correlated with mental health at all time periods. Patients with optimized mental health may report higher outcome scores following CDR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

ACDF:

Anterior cervical discectomy and fusion

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CCI:

Charlson Comorbidity Index

CDR:

Cervical disc replacement

DDD:

Degenerative disc disease

EBL:

Estimated blood loss

LOS:

Length of stay

MCS:

Mental Component Score

MDD:

Major depressive disorder

NDI:

Neck Disability Index

OME:

Oral morphine equivalents

ORA:

Office of Regulatory Affairs

PCS:

Physical Component Score

PHQ-9:

Patient Health Questionnaire-9

POD:

Postoperative day

PROMIS-PF:

Patient-Reported Outcomes Measurement Information System Physical Function

PROMs:

Patient-reported outcome measures

SF-12 PCS:

12-Item Short Form

VAS:

Visual analog scale

References

  1. Adogwa O, Verla T, Thompson P, Penumaka A, Kudyba K, Johnson K, Fulchiero E, Miller T Jr, Hoang KB, Cheng J, Bagley CA (2014) Affective disorders influence clinical outcomes after revision lumbar surgery in elderly patients with symptomatic adjacent-segment disease, recurrent stenosis, or pseudarthrosis: clinical article. J Neurosurg Spine 21(2):153–159. https://doi.org/10.3171/2014.4.SPINE12668

    Article  PubMed  Google Scholar 

  2. Archer KR, Abraham CM, Obremskey WT (2015) Psychosocial Factors Predict Pain and Physical Health After Lower Extremity Trauma. Clin Orthop Relat Res 473(11):3519–3526. https://doi.org/10.1007/s11999-015-4504-6

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bakhsheshian J, Scheer JK, Gum JL, Hostin R, Lafage V, Bess S, Protopsaltis TS, Burton DC, Keefe MK, Hart RA, Mundis GM Jr, Shaffrey CI, Schwab F, Smith JS, Ames CP, International Spine Study Group (2017) Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up. J Neurosurg Spine 26(1):116–124. https://doi.org/10.3171/2016.5.SPINE151428

    Article  PubMed  Google Scholar 

  4. Boakye M, Moore R, Kong M, Skirboll SL, Arrigo RT (2013) Health-related quality-of-life status in Veterans with spinal disorders. Qual Life Res 22(1):45–52. https://doi.org/10.1007/s11136-012-0121-y

    Article  PubMed  Google Scholar 

  5. Boden SH, Farley KX, Campbell C, Boden SD, Gottschalk MB (2020) Rational Selection of Patient-Reported Outcomes Measures in Lumbar Spine Surgery Patients. Int J Spine Surg 14(3):347–354. https://doi.org/10.14444/7046

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chen DA, Vaishnav AS, Louie PK et al (2020) Patient Reported Outcomes in Patients Who Stop Following Up: Are They Doing Better or Worse Than the Patients That Come Back? Spine 45(20):1435–1442

    Article  PubMed  Google Scholar 

  7. Chen PJ, Pusica Y, Sohaei D, Prassas I, Diamandis EP (2021) An overview of mental health during the COVID-19 pandemic. Diagnosis 8(4):403–412. https://doi.org/10.1515/dx-2021-0046

    Article  CAS  PubMed  Google Scholar 

  8. Colantonio DF, Nassr A, Freedman BA, Elder BD, Bydon M, Helgeson MD, Kepler CK, Sebastian AS, Wagner SC (2022) The Effect of Preoperative Mental Health Status on Outcomes After Anterior Cervical Discectomy and Fusion. Int J Spine Surg 16(2):233–239. https://doi.org/10.14444/8211

    Article  PubMed  PubMed Central  Google Scholar 

  9. Cushnie D, Fisher C, Hall H, Johnson M, Christie S, Bailey C, Phan P, Abraham E, Glennie A, Jacobs B, Paquet J, Thomas K (2021) Mental health improvements after elective spine surgery: a Canadian Spine Outcome Research Network (CSORN) study. Spine J 21(8):1332–1339. https://doi.org/10.1016/j.spinee.2021.03.032

    Article  CAS  PubMed  Google Scholar 

  10. Delgado DA, Lambert BS, Boutris N et al (2018) Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2(3):e088. https://doi.org/10.5435/JAAOSGlobal-D-17-00088

  11. Divi SN, Goyal D, Mangan JJ, Galetta MS, Nicholson KJ, Fang T, Goyal S, Booth TJ, Tarazona D, Lucasti C, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Anderson DG, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD (2020) Are Outcomes of Anterior Cervical Discectomy and Fusion Influenced by Presurgical Depression Symptoms on the Mental Component Score of the Short Form-12 Survey? Spine 45(3):201–207. https://doi.org/10.1097/BRS.0000000000003231

    Article  PubMed  Google Scholar 

  12. Gornet MF, Copay AG, Schranck FW, Kopjar B (2016) Observational study of depression in patients undergoing cervical disc arthroplasty: evidence of a correlation between pain relief and resolution of depression. Int J Spine Surg 10:11. https://doi.org/10.14444/3011

  13. Haws BE, Khechen B, Bawa MS, Patel DV, Bawa HS, Bohl DD, Wiggins AB, Cardinal KL, Guntin JA, Singh K (2019) The Patient-Reported Outcomes Measurement Information System in spine surgery: a systematic review. J Neurosurg Spine 30(3):405–413. https://doi.org/10.3171/2018.8.SPINE18608

    Article  PubMed  Google Scholar 

  14. He J, Xiong W, Li F, Luo W, Gao SC (2017) Depression influences pain and function after cervical disc arthroplasty. J Neurosurg Sci 61(1):39–45. https://doi.org/10.23736/S0390-5616.16.03032-0

    Article  PubMed  Google Scholar 

  15. Hoogendam L, van der Oest M, Tsehaie J, Wouters RM, Vermeulen GM, Slijper HP, Selles RW, Porsius JT, Hand-Wrist Study Group (2021) Psychological factors are more strongly associated with pain than radiographic severity in non-invasively treated first carpometacarpal osteoarthritis. Disabil Rehabil 43(13):1897–1902. https://doi.org/10.1080/09638288.2019.1685602

    Article  PubMed  Google Scholar 

  16. IsHak WW, Wen RY, Naghdechi L, Vanle B, Dang J, Knosp M, Dascal J, Marcia L, Gohar Y, Eskander L, Yadegar J, Hanna S, Sadek A, Aguilar-Hernandez L, Danovitch I, Louy C (2018) Pain and Depression: A Systematic Review. Harv Rev Psychiatry 26(6):352–363. https://doi.org/10.1097/HRP.0000000000000198

    Article  PubMed  Google Scholar 

  17. Jenkins NW, Parrish JM, Yoo JS, Patel DS, Hrynewycz NM, Brundage TS, Singh K (2020) Are Preoperative PHQ-9 Scores Predictive of Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion? Clin Spine Surg 33(10):E486–E492. https://doi.org/10.1097/BSD.0000000000000985

    Article  PubMed  Google Scholar 

  18. Jiao J, Tang H, Zhang S, Qu X, Yue B (2021) The relationship between mental health/physical activity and pain/dysfunction in working-age patients with knee osteoarthritis being considered for total knee arthroplasty: a retrospective study. Arthroplasty 3(1):22. https://doi.org/10.1186/s42836-021-00077-5

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee H, Hübscher M, Moseley GL, Kamper SJ, Traeger AC, Mansell G, McAuley JH (2015) How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain. Pain 156(6):988–997. https://doi.org/10.1097/j.pain.0000000000000146

    Article  PubMed  Google Scholar 

  20. MacDowall A, Skeppholm M, Lindhagen L, Robinson Y, Olerud C (2018) Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy. J Neurosurg Spine 29(4):371–379. https://doi.org/10.3171/2018.2.SPINE171378

    Article  PubMed  Google Scholar 

  21. Mak IW, Chu CM, Pan PC, Yiu MG, Chan VL (2009) Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry 31(4):318–326. https://doi.org/10.1016/j.genhosppsych.2009.03.001

    Article  PubMed  PubMed Central  Google Scholar 

  22. Murphy SL, Lyden AK, Phillips K, Clauw DJ, Williams DA (2011) Association between pain, radiographic severity, and centrally-mediated symptoms in women with knee osteoarthritis. Arthritis Care Res 63(11):1543–1549. https://doi.org/10.1002/acr.20583

    Article  Google Scholar 

  23. Oshima Y, Matsubayashi Y, Taniguchi Y, Hayakawa K, Fukushima M, Oichi T, Oka H, Riew KD, Tanaka S (2019) Mental State Can Influence the Degree of Postoperative Axial Neck Pain Following Cervical Laminoplasty. Global spine journal 9(3):292–297. https://doi.org/10.1177/2192568218793861

    Article  PubMed  Google Scholar 

  24. Parrish JM, Jenkins NW, Nolte MT, Massel DH, Hrynewycz NM, Brundage TS, Singh K (2020) A Validation of Patient Health Questionnaire-9 for Cervical Spine Surgery. Spine 45(23):1668–1675. https://doi.org/10.1097/BRS.0000000000003644

    Article  PubMed  Google Scholar 

  25. Pu B, Li C, Li J, Ying T, Hua C, Liu K, Li F, Huang Z, Zhao C, Li X (2019) Improvement of quality of life and mental health in patients with spasmodic torticollis after microvascular decompression. Clin Neurol Neurosurg 180:57–60. https://doi.org/10.1016/j.clineuro.2019.03.001

    Article  PubMed  Google Scholar 

  26. Riddle DL, Jensen MP, Ang D, Slover J, Perera R, Dumenci L (2018) Do Pain Coping and Pain Beliefs Associate With Outcome Measures Before Knee Arthroplasty in Patients Who Catastrophize About Pain? A Cross-sectional Analysis From a Randomized Clinical Trial. Clin Orthop Relat Res 476(4):778–786. https://doi.org/10.1007/s11999.0000000000000001

    Article  PubMed  PubMed Central  Google Scholar 

  27. Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, Rasoulpoor S, Khaledi-Paveh B (2020) Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Glob Health 16(1):57. https://doi.org/10.1186/s12992-020-00589-w

    Article  Google Scholar 

  28. StataCorp (2023) Stata Statistical Software: Release 18. StataCorp LLC, College Station, TX

    Google Scholar 

  29. Talevi D, Socci V, Carai M, Carnaghi G, Faleri S, Trebbi E, di Bernardo A, Capelli F, Pacitti F (2020) Mental health outcomes of the CoViD-19 pandemic. Rivista di psichiatria 55(3):137–144. https://doi.org/10.1708/3382.33569

    Article  PubMed  Google Scholar 

  30. Umucu E, Reyes A, Carrola P, Mangadu T, Lee B, Brooks JM, Fortuna KL, Villegas D, Chiu CY, Valencia C (2021) Pain intensity and mental health quality of life in veterans with mental illnesses: the intermediary role of physical health and the ability to participate in activities. Qual Life Res 30(2):479–486. https://doi.org/10.1007/s11136-020-02642-y

    Article  PubMed  Google Scholar 

  31. Vindegaard N, Benros ME (2020) COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun 89:531–542. https://doi.org/10.1016/j.bbi.2020.05.048

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Widbom-Kolhanen S, Pernaa KI, Saltychev M (2022) Reliability and validity of the Neck Disability Index among patients undergoing cervical surgery. Int J Rehabil Res 45(3):273–278. https://doi.org/10.1097/MRR.0000000000000540

    Article  PubMed  Google Scholar 

  33. Wilson BR, Tringale KR, Hirshman BR, Zhou T, Umlauf A, Taylor WR, Ciacci JD, Carter BS, Chen CC (2017) Depression After Spinal Surgery: A Comparative Analysis of the California Outcomes Database. Mayo Clin Proc 92(1):88–97. https://doi.org/10.1016/j.mayocp.2016.06.030

    Article  PubMed  Google Scholar 

  34. Yoo JS, Jenkins NW, Parrish JM, Brundage TS, Hrynewycz NM, Mogilevsky FA, Singh K (2020) Evaluation of Postoperative Mental Health Outcomes in Patients Based on Patient-Reported Outcome Measurement Information System Physical Function Following Anterior Cervical Discectomy and Fusion. Neurospine 17(1):184–189. https://doi.org/10.14245/ns.1938256.128

    Article  PubMed  PubMed Central  Google Scholar 

  35. Zhang J, Lu H, Zeng H, Zhang S, Du Q, Jiang T, Du B (2020) The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun 87:49–50. https://doi.org/10.1016/j.bbi.2020.04.031

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

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

    Keith R. MacGregor, Timothy J. Hartman, James W. Nie, Eileen Zheng, Omolabake O. Oyetayo, Dustin H. Massel, Arash J. Sayari & Kern Singh

Authors
  1. Keith R. MacGregor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy J. Hartman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James W. Nie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eileen Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Omolabake O. Oyetayo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Dustin H. Massel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Arash J. Sayari
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kern Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Conflict of interest

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.

Additional information

Comments

The authors present a study concerning 151 patients who had undergone cervical disc replacement (CDR). The aim was to analyse the correlation between the patient-reported mental health and the self-reported outcome measures (PROMs) physical function, pain and disability, preoperatively and at 6 weeks, 3 months, 6 months and 1 year after the CDR. Significant correlations were seen between the patient-reported mental health measures and the physical function, pain and disability PROMs at multiple time-points postoperatively. Psychiatric problems could go under the radar in the highly specialized healthcare. The present study underlines the importance of also taking the CDR-patients mental health into account, in order to achieve an optimal postoperative outcome.

Åsa Bergendal

Stockholm

Sweden

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

MacGregor, K.R., Hartman, T.J., Nie, J.W. et al. Poor patient-reported mental health correlates with inferior patient-reported outcome measures following cervical disc replacement. Acta Neurochir 165, 3511–3519 (2023). https://doi.org/10.1007/s00701-023-05774-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-023-05774-5

Keywords

Search

Navigation