Depression among lumbar spine surgery patients: Uncovering the untold story

TL;DR

Many spine surgery patients have undiagnosed depression, which affects their recovery, and a tool called PROMIS can help identify these patients.

Contribution

PROMIS Depression scores effectively identify undiagnosed depression in spine surgery patients.

Findings

24.1% of patients without a depression diagnosis were identified as at-risk using PROMIS scores.

ARUD patients had significantly worse outcomes than those without depression.

PROMIS scores correlated strongly with anxiety and moderately with other health domains.

Abstract

Depression is highly prevalent among patients with
lumbar degenerative disease and is associated with worse postoperative outcomes.
However, a significant proportion of affected individuals remain undiagnosed. We
aimed to evaluate the utility of PROMIS Depression scores in identifying
patients with undiagnosed depression undergoing lumbar spine surgery and to
characterize their clinical outcomes relative to patients with diagnosed and no
depression.

This retrospective cohort study included patients
undergoing 1- or 2-level lumbar decompression or fusion between March 2019 and
November 2021. Patients were stratified into three cohorts: diagnosed depression
(PDD), no depression (NDD), and at-risk for undiagnosed depression (ARUD),
defined as PROMIS Depression ≥55 without an ICD-10 diagnosis. Patient-reported
outcomes were assessed preoperatively and at 6, 12, and 24 months
postoperatively. Between group comparisons and baseline-adjusted ANCOVA models
were performed, including subgroup analyses by procedure type (fusion vs.
decompression) and revision status.

Of 286 ICD-10-negative patients, 24.1% (n=69) met
criteria for ARUD. Patient-reported outcome scores across all domains in the
ARUD cohort mirrored those of the PDD group and were significantly worse than
those of the NDD cohort at all timepoints (p<.001). PROMIS Depression
showed a strong correlation with Anxiety (ρ>0.77) and moderate
correlations with other domains. No significant difference was observed in
outcomes between treated and untreated PDD patients. Older age was associated
with reduced likelihood of diagnosis, while substance abuse history, pain clinic
enrollment, and retired status predicted higher risk of undiagnosed
depression.

PROMIS Depression scores can identify patients with
undiagnosed depression who experience similar impairments and postoperative
outcomes as those with diagnosed depression. These findings support the routine
use of PROMIS Depression as a screening tool to enhance preoperative psychiatric
assessment in spine surgery patients.

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