Mental Health Impact on Outcomes After Anterior Cervical Discectomy

Overview

This cohort study analyzed the influence of baseline mental health, measured by the Hospital Anxiety and Depression Scale (HADS), on functional outcomes following anterior cervical discectomy. Results demonstrated that poorer baseline mental health is associated with worse postoperative Neck Disability Index (NDI) scores, and a predictive model was developed to aid preoperative counseling.

Background

Depression and anxiety are prevalent among patients with chronic pain and have been shown to negatively affect pain perception and recovery. Prior research indicates that psychological disorders correlate with higher postoperative complications and poorer functional outcomes in spine surgery, though evidence specific to cervical spine procedures remains limited. This study aimed to quantify the effect size of mental health on postoperative function after anterior cervical spine surgery and to develop a predictive tool for clinical use.

Data Highlights

Key Findings

• Patients with higher baseline HADS scores (cases) had significantly worse NDI scores postoperatively compared to non-cases.
• Generalized estimating equations showed that baseline mental health status influenced the trajectory of functional recovery over 2 years.
• A predictive linear mixed model incorporating baseline HADS and NDI scores accurately forecasted 1- and 2-year postoperative NDI outcomes.
• Changes in HADS scores over time correlated with changes in NDI, indicating mental health improvements parallel functional recovery.
• An R Shiny application was developed to facilitate individualized preoperative counseling based on the predictive model.

Clinical Implications

Assessment of mental health using HADS prior to anterior cervical discectomy can identify patients at risk for poorer functional outcomes. Incorporating mental health status into preoperative counseling and decision-making may improve patient expectations and guide interventions. The predictive model and application provide clinicians with a practical tool to personalize prognosis discussions.

Conclusion

Baseline mental health significantly affects postoperative functional outcomes after anterior cervical discectomy. Utilizing predictive modeling of mental health and disability scores enhances preoperative patient counseling and may inform tailored perioperative management strategies.

References

1. JAMA Internal Medicine 2014 -- Prevalence of Major Depression in Pain Patients
2. NECK Trial Protocol and Outcomes 2018, 2020 -- Anterior Cervical Discectomy Randomized Controlled Trial
3. Hospital Anxiety and Depression Scale Validation Studies 1983, 1997
4. Neck Disability Index Validation Studies 1991, 2000