Preoperative patient anxiety and depression reduces impact of cervical radiculopathy surgery


Martin Skeppholm, Stockholm Spine Centre, Stockholm, Sweden, told delegates at the Cervical Spine Research Society European Section (CSRS-ES; 27–28 May, London, UK) meeting that patients with preoperative anxiety and depression see worse self-assessed outcomes following cervical radiculopathy surgery.

This is, Skeppholm pointed out, a difficult area, as “pain signals are always modulated, and can be enhanced or inhibited by different mechanisms, which can differ between individuals.”

Skeppholm and colleagues’ study involved 151 patients who were undergoing treatment in a randomised control trial comparing anterior cervical discectomy and fusion (ACDF) and artificial disc replacement, and followed them up at two years after surgery. The primary outcome measure for the cohort (which was 52%/48% male/female with a mean age of 47 years) was the neck disability index (NDI). Preoperative anxiety and depression were evaluated with the Hospital Anxiety and Depression scale (HADa for anxiety and HADd for depression). A HAD score of 11–21 suggests a high risk for manifest depression and/or anxiety. Other baseline data such as age, gender, smoking status, level and duration of pain, sick leave, unemployment and use of analgesics were also collected. Preoperative possible risk factors were correlated to NDI at two years postoperative and computed in a linear regression model.

The collected data indicate that “anxiety and depression as measured by HAD constituted the major factors for the variance in NDI after two years,” said Skeppholm. Patients with low anxiety scores (HADa<11; n=104) and depression (HADd<11; n=124) had mean preoperative NDI scores of 59 and 60, respectively, while those with high HADa and HADd scores (>11; n=32 anxiety and n=12 depression) had corresponding NDI scores of 68 and 74. At two years, the low scoring patients’ mean NDI scores were 30 (HADa) and 32 (HADd) while the high-scoring group scores were 54 (HADa) and 56 (HADd). As Skeppholm noted, “The difference was statistically significant, even after Bonferroni correction” (p<0.01).

“The patients who scored highly on the HAD and NDI scales also showed a statistically significant improvement after surgery,” Skeppholm explained to Spinal News International. “Both the patients that scored low and high on HAD improved after surgery but the high scorers did not improve to the same extent.”

Skeppholm told delegates that, as the results suggest that preoperative anxiety and depression results in less improvement in NDI following surgery, “more studies are needed to investigate whether this group of patients may achieve better results if other treatments are offered, either nonsurgical treatment alone or as an adjunct to surgery.” He also believes that “Screening, with the intention of detecting mental distress, should be part of the preoperative evaluation in clinical settings where surgery for radiculopathy is performed.”