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Research ArticleLumbar Spine

Predicting Acute Changes in Depressive Symptoms Following Lumbar Decompression

Conor P. Lynch, Elliot D.K. Cha, Madhav R. Patel, Kevin C. Jacob, Shruthi Mohan, Cara E. Geoghegan, Caroline N. Jadczak and Kern Singh
International Journal of Spine Surgery December 2022, 16 (6) 953-959; DOI: https://doi.org/10.14444/8332
Conor P. Lynch
1 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
MS
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Elliot D.K. Cha
1 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
MS
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Madhav R. Patel
1 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
BS
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Kevin C. Jacob
1 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
BS
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Shruthi Mohan
1 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
BS
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Cara E. Geoghegan
1 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
BS
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Caroline N. Jadczak
1 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
BS
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Kern Singh
1 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
MD
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  • For correspondence: kern.singh@rushortho.com
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    Table 1

    Patient demographics by depression symptom subgroup.

    DemographicMinimal (n = 109)Mild (n = 64)Moderate to Severe (n = 43) P Valuea
    Age, y0.045
     <5049.5% (54)40.6% (26)65.1% (28)
     ≥5050.5% (55)59.4% (38)34.9% (15)
    Gender0.090
     Women22.9% (25)37.5% (24)34.9% (15)
     Men77.1% (84)62.5% (40)65.1% (28)
    Body mass index0.031
     <30 kg/m2 63.3% (69)43.7% (28)48.8% (21)
     ≥30 kg/m2 36.7% (40)56.3% (36)51.2% (22)
    Race<0.001
     Nonwhite15.7% (17)31.2% (20)51.2% (21)
     White84.3% (91)68.7% (44)48.8% (20)
    Smoking status0.408
     Nonsmoker92.7% (101)92.2% (59)86.1% (37)
     Smoker7.3% (8)7.8% (5)13.9% (6)
    Diabetic status0.050
     Diabetic95.4% (104)85.9% (55)95.3% (41)
     Nondiabetic4.6% (5)14.1% (9)4.7% (2)
    American Society of Anesthesiologists score0.953
     <286.2% (94)87.1% (54)88.1% (37)
     ≥213.8% (15)12.9% (8)11.9% (5)
    Charlson Comorbidity Index score0.745
     <167.1% (55)69.9% (28)67.7% (21)
     ≥132.9% (25)39.1% (18)32.3% (10)
    VAS back0.267
     <757.1% (60)44.3% (27)50.0% (21)
     ≥742.9% (45)55.7% (34)50.0% (21)
    VAS leg0.159
     <764.8% (68)59.0% (36)47.6% (20)
     ≥735.2% (37)41.0% (25)52.4% (22)
    Insurance0.003
     Medicare/Medicaid4.6% (5)1.5% (1)4.7% (2)
     Workers’ compensation8.3% (9)25.0% (16)32.6% (14)
     Private87.2% (95)73.4% (47)62.8% (27)
    • Abbreviation: VAS, visual analog scale.

    • Note: Data presented as (%) n.

    • ↵a P value calculated using χ 2 test.

    • View popup
    Table 2

    Perioperative characteristics by depressive symptom subgroup.

    CharacteristicsMinimal (n = 109)Mild (n = 64)Moderate to Severe (n = 43) P Valuea
    Spinal pathology
     Herniated nucleus pulposus71.6% (78)62.5% (40)76.7% (33)0.102
     Foraminal stenosis58.7% (64)57.8% (37)72.1% (31)0.254
     Spinal stenosis89.0% (97)92.2% (59)90.7% (39)0.787
    Decompression0.212
     Single level77.8% (84)85.7% (54)88.4% (38)
     Multilevel22.2% (24)14.3% (9)11.6% (5)
     Operative time, min44.7 ± 16.345.5 ± 19.546.1 ± 19.00.907
     Estimated blood loss, mL26.7 ± 7.926.2 ± 6.926.1 ± 5.90.863
     Length of stay, h7.4 ± 13.66.8 ± 9.56.7 ± 10.40.927
    • Note: Data presented as (%) n or mean ± SD.

    • ↵a P value calculated using χ 2 test or analysis of variance.

    • View popup
    Table 3

    Improvement in PHQ-9 after lumbar decompression.

    TimepointPHQ-9 Score, Mean ± SE P Valuea
    Preoperative6.1 ± 0.5–
    6 wk3.3 ± 0.4<0.001
    12 wk3.9 ± 0.6<0.001
    6 mo3.8 ± 0.5<0.001
    • Abbreviation: PHQ-9, Patient Health Questionnaire-9.

    • ↵a P values calculated using paired t test.

    • View popup
    Table 4

    Significant predictors of change in postoperative depression.

    VariableCoefficient, ßSE95% CI P Valuea
    6 wk
     Mild PHQ-9−4.480.94−6.68−2.93<0.001
     Moderate to severe PHQ-9−8.131.17−10.46−5.80<0.001
    12 wk
     Mild PHQ-9−3.571.59−6.77−0.370.029
     Moderate to severe PHQ-9−10.081.97−14.04−6.11<0.001
     Private insurance−5.491.72−8.94−2.040.002
     Smoking3.911.920.067.780.047
    6 mo
     Moderate to severe PHQ-9−4.632.16−9.00−0.270.038
    • Abbreviation: PHQ-9, Patient Health Questionnaire-9.

    • ↵a P values calculated using multiple linear regression analysis.

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International Journal of Spine Surgery
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1 Dec 2022
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Predicting Acute Changes in Depressive Symptoms Following Lumbar Decompression
Conor P. Lynch, Elliot D.K. Cha, Madhav R. Patel, Kevin C. Jacob, Shruthi Mohan, Cara E. Geoghegan, Caroline N. Jadczak, Kern Singh
International Journal of Spine Surgery Dec 2022, 16 (6) 953-959; DOI: 10.14444/8332

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Predicting Acute Changes in Depressive Symptoms Following Lumbar Decompression
Conor P. Lynch, Elliot D.K. Cha, Madhav R. Patel, Kevin C. Jacob, Shruthi Mohan, Cara E. Geoghegan, Caroline N. Jadczak, Kern Singh
International Journal of Spine Surgery Dec 2022, 16 (6) 953-959; DOI: 10.14444/8332
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Keywords

  • depression
  • 9-Item Patient Health Questionnaire (PHQ-9)
  • lumbar decompression (LD)
  • postoperative
  • acute

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