Perception of Physical Function, Pain, and Disability Outcomes Are Strongly Correlated with Mental Health up to Two Years After Lumbar Decompression

Introduction: Preoperative mental health has been demonstrated associations with postoperative outcomes in spine surgery; yet few studies have evaluated mental health correlation with other outcomes at time of patient-reported outcome measure (PROM) collection.

Methods: Retrospective search of a single-surgeon database was performed for patients who had undergone LD. PROMs were collected preoperatively and at several intervals up to 2 years postoperatively. PROMs evaluated included Patient Health Questionnaire-9 (PHQ-9), 12-item Short Form Mental Component Score (SF-12 MCS) and Physical Component Score (SF-12 PCS), Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Component Score (PCS), visual analog scale (VAS) back and leg pain, and Oswestry Disability Index (ODI). SF-12 MCS and PHQ-9 were separately compared to other PROMs utilizing Pearson’s correlation tests.

Results: 1,158 patients were included. SF-12 MCS significantly positively correlated with PROMIS PF at all periods (range: r=0.255-0.529, p< 0.001) and SF-12 PCS at all postoperative periods (range: r=0.213-0.390, p< 0.001). SF-12 MCS significantly negatively correlated with VAS back (range: r=-0.202 to -0.454), VAS leg (range: r=-0.219 to -0.451), and ODI (range: r=-0.356 to -0.521) at all periods (p≤0.005, all). PHQ-9 significantly negatively correlated with PROMIS PF (range: r=-0.322 to -0.609) and SF-12 PCS (range: r=-0.219 to -0.621) at all periods (p < 0.001, all). PHQ-9 significantly positively correlated with VAS back (range: r=0.246-0.616), VAS leg (range: r=0.221-0.600), and ODI (range: r=0.483-0.672) at all periods (p < 0.001, all).

Conclusion : Inferior mental health at time of PROM survey collection demonstrated strong correlation to inferior outcomes with regard to physical function, pain, and disability outcomes as measured by both SF-12 MCS and PHQ-9 forms. PHQ-9 demonstrated stronger correlation to all outcomes. Optimization of mental health in patients undergoing lumbar decompression surgery may beneficially impact patient outcomes.