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Poor mental health scores correlate with inferior outcomes following minimally invasive transforaminal lumbar interbody fusion

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Abstract

Background

Limited spine literature has studied the strength of association of mental health with other outcomes at time of survey collection. We aim to evaluate the degree to which mental health correlates with outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) at several postoperative periods.

Methods

Patients having undergone elective MIS-TLIF were searched within a retrospective single-surgeon database. Five hundred eighty-five patients were included. Patient-reported outcomes (PROs) including Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF), 12-item Short Form Physical Component Score (SF-12 PCS) and Mental Component Score (SF-12 MCS), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) back and leg pain, and Oswestry Disability Index (ODI) scores were collected preoperatively and at 6-week, 12-week, 6-month, 1-year, and 2-year periods. Pearson’s correlation tests were used to evaluate the association between both SF-12 MCS and PHQ-9 scores to other PROs at each period.

Results

SF-12 MCS correlated with PROMIS PF (|r|= 0.308–0.531), SF-12 PCS (|r|= 0.207–0.328), VAS back (|r|= 0.279–0.474), VAS leg (|r|= 0.178–0.395), and ODI (|r|= 0.450–0.538) at all time points (P ≤ 0.021, all) except for preoperative SF-12 PCS and 1-year VAS leg. PHQ-9 correlated with PROMIS PF (|r|= 0.366–0.701), SF-12 PCS (|r|= 0.305–0.568), VAS back (|r|= 0.362–0.714), VAS leg (|r|= 0.319–0.694), and ODI (|r|= 0.613–0.784) at all periods (P < 0.001, all).

Conclusion

Poor mental health scores were correlated with lower physical function, elevated pain scores, and higher disability. PHQ-9 scores demonstrated stronger correlation in all relationships compared to SF-12 MCS. Optimization of patient mental health may lead to improved patient perception regarding function, pain, and disability following MIS-TLIF.

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Data Availability

Limited data is available from the authors upon reasonable request.

Abbreviations

BMI:

Body mass index

EBL:

Estimated blood loss

LOS:

Length of stay

MIS-TLIF:

Minimally invasive transforaminal lumbar interbody fusion

ODI:

Oswestry Disability Index

PHQ-9:

9-Item Patient Health Questionnaire

PRO:

Patient-reported outcomes

PROMIS PF:

Patient-Reported Outcome Measurement Information System Physical Function

SF-12 MCS:

12-Item Short Form Mental Component Score

SF-12 PCS:

12-Item Short Form Physical Component Score

SF-36:

36-Item Short Form

VAS:

Visual Analog Scale

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Funding

This research did not receive any specific grant from public, commercial, or not-for-profit funding agencies.

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, Eileen Zheng, Omolabake O. Oyetayo, Keith R. MacGregor & Kern Singh

Authors
  1. Timothy J. Hartman
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  2. James W. Nie
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  3. Eileen Zheng
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  4. Omolabake O. Oyetayo
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  5. Keith R. MacGregor
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  6. Kern Singh
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Contributions

Timothy J. Hartman: conceptualization, methodology, visualization, formal analysis, software, investigation, writing—original draft, writing—review and editing. James W. Nie: conceptualization, methodology, visualization, formal analysis, software, investigation, writing—original draft, writing—review and editing. Eileen Zheng: project administration, data curation, investigation, writing—review and editing. Omolabake O. Oyetayo: project administration, data curation, investigation, writing—review and editing. Keith R. MacGregor: project administration, data curation, investigation, writing—review and editing. Kern Singh: conceptualization, methodology, supervision, resources, investigation, writing—review and editing.

Corresponding author

Correspondence to Kern Singh.

Ethics declarations

Ethical approval and consent to participate

Prior to the initiation of this retrospective study, Institutional Review Board approval was also obtained along with informed consent from patients at Rush University Medical Center, including consent to the use of all information from this patient in a manner that protects his/her identity.

Consent for publication

Patients consented to the use of all information for scientific and educational purposes in a manner that protects their identity.

Conflict of interest

The authors declare no competing interests.

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Comments

In the present study of patients who have undergone minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), the authors investigated the correlation between patient-reported mental health and physical function, pain, and disability, preoperatively and longitudinally at different time points after operation. A low mental health score was found to be associated with poor physical function and higher level of pain, respectively, disability up to 2 years postoperatively. This finding emphasizes the importance of taking account of mental health issues in the overall care of these patients.

Åsa Bergendal

Stockholm, Sweden

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Hartman, T.J., Nie, J.W., Zheng, E. et al. Poor mental health scores correlate with inferior outcomes following minimally invasive transforaminal lumbar interbody fusion. Acta Neurochir 165, 1931–1942 (2023). https://doi.org/10.1007/s00701-023-05557-y

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