Does Comorbid Self-reported Depression and Anxiety Influence Outcomes Following Surgery for Cervical Spondylotic Myelopathy?

Introduction: Depression and anxiety are associated with inferior outcomes following spine surgery. This study examines whether patients with CSM who have both self-reported depression (SRD) and anxiety (SRA) have worse postoperative patient-reported outcomes (PROs) compared to those who have only one or none of these comorbidities.

Methods: This is a retrospective analysis of prospectively-collected data from the Quality Outcomes Database CSM module. Comparisons were made among patients who self-reported (1) either SRD or SRA, (2) both SRD and SRA, and (3) neither comorbidity at baseline. Twenty-four-month PROs (VAS-neck, VAS-arm, NDI, mJOA, EQ-5D, EQ-VAS, NASS satisfaction) and achievement of respective PRO minimum clinically important differences (MCID) were compared.

Results: Of the 1,141 included patients, 199 (17.4%) had either SRD or SRA alone, 132 (11.6%) had both SRD and SRA, and 810 (71.0%) had neither (non-SRD/A). Preoperatively, patients with either SRD or SRA alone had worse VAS-neck (5.62±3.11 vs 5.07±3.29,p=0.03), NDI (41.0±19.3 vs 36.8±20.8,p=0.007), EQ-VAS (57.0±21.0 vs 60.7±21.7,p=0.03), and EQ-5D (0.53±0.23 vs 0.58±0.21,p=0.008) compared to those without such disorders. At 24 months, SRD or SRA alone experienced less EQ-5D change and were less likely to meet MCID for EQ-5D compared to those without SRD or SRA. Importantly, self-reporting both psychological comorbidities did not impact PROs at all measured time points compared to self-reporting only one psychological comorbidity alone. All 3 cohorts experienced mean significant improvements in PROs compared to baseline (p < 0.05).

Conclusion : Approximately 12% of patients operated for CSM present with both self-reported depression and anxiety, while 29% present with at least one symptom. At 24-month follow-up, patients with self-reported depression or anxiety experienced lower quality of life compared to those without self-reported depression or anxiety. The comorbid presence of both depression and anxiety was not associated with worse outcomes compared to either diagnosis alone.