Increased Depressive Burden in the Early Postoperative Period Is Associated with Inferior Long-term Outcomes After Cervical Disc Replacement

Introduction: There is a lack of data evaluating the correlation between summative depressive burden and PROs following CDR. We aim to evaluate the correlation between early depressive burden via summative 9-Item Patient Health Questionnaire (PHQ-9) and patient-reported outcomes (PROs) after cervical disc replacement (CDR).

Methods: Retrospective search of a single-surgeon registry was conducted for patients who underwent elective CDR. Three-month summative depressive burden was calculated via arithmetic addition of PHQ-9 scores at preoperative, 6-week, and 3-month periods. Patients were excluded if missing preoperative, 6-week, or 3-month PHQ-9 data. Demographic and perioperative characteristics were collected. Relationships between summative depressive burden and PROs at 3-month, 6-month, and 1-year time were examined via paired Pearson’s correlation tests. PROs evaluated included Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Visual Analog Scale (VAS) Neck pain, VAS Arm pain, and Neck Disability Index (NDI) scores.

Results: Fifty-six patients were identified as meeting inclusion criteria. Mean summative depressive burden in this population was 16.2. 3-month correlation coefficients were -0.615 for PROMIS-PF, 0.597 for VAS Neck, 0.577 for VAS Arm, and 0.659 for NDI (p < 0.001, all). 6-month correlation coefficients were -0.487 for PROMIS-PF, 0.559 for VAS Neck, 0.455 for VAS Arm, and 0.616 for NDI (p≤0.020, all). 1-year correlation coefficients were -0.635 for PROMIS-PF, 0.544 for VAS Neck, 0.608 for VAS Arm, and 0.749 for NDI (p≤0.001, all).

Conclusion : Three-month summative depressive burden, scored via PHQ-9, consistently demonstrated strong correlations with patient-reported outcome measures of physical function, pain, and disability up to 1-year following cervical disc replacement. Patients with chronically inferior mental health scores may experience inferior long-term outcomes after intervention. Patients at-risk can be readily identified via combined PHQ-9 screening pre- and post-operatively. Further studies should determine threshold levels for at-risk patients and evaluate efficacy of supplemental non-operative interventions.