What Is the Effect of Preoperative Depression on Outcomes After Minimally Invasive Surgery for Adult Spinal Deformity? A Prospective Cohort Analysis Using a Multicenter Registry

Introduction: Depression has been implicated with worse immediate preoperative outcomes, yet the specific impact on outcomes requires further clarity. This study aims to evaluate the role of depression in patients with adult spinal deformity (ASD) in the perioperative setting.

Methods: Patients undergoing minimally invasive surgery (MIS) for ASD with a minimum of two years of postoperative follow-up were included from a prospectively collected, multicenter registry. Two cohorts of patients were identified consisting of those either affirming or denying depression on preoperative assessment. The patient-reported outcomes (PROs) compared included ODI, NRS back and leg pain, SRS-22r, SF-36 PCS, SF-36 MCS, EQ-5D, and EQ-5D VAS. Univariate comparisons were conducted with t-tests as well as nonparametric tests. Categorical variables were compared using the Fisher’s exact test.

Results: A total of 15 out of the 85 (17.6%) patient study cohort screened positive for preoperative depression. At 2-year follow-up only 7 patients still reported depression, representing a 53.3% decrease. Both cohorts did demonstrate improvement in their patient reported outcomes; however, at 2-year follow-up those without depression had statistically better outcomes based on the EQ-5D (p < 0.05), EQ-5D VAS (p < 0.01), and MCS (p < 0.01). No significant differences were observed between the two cohorts with regards to the Charlson comorbidity index, spinopelvic parameters, treatment data, or complications.

Conclusion : Despite the relatively high frequency of ASD patients reporting preoperative depression, improvements were observed in their PROs at 2-year follow-up after undergoing MIS. However, those without depression had statistically significant better PROs. Nevertheless, the number of patients screening positive for depression on follow-up after surgery decreased by over 50%. Mental health screening and services remain an integral part of perioperative patient care.