目的:抑郁症与成人脊柱畸形(ASD)矫正术后近期预后较差有关,然而,抑郁对接受微创手术(MIS)的患者的具体影响还需要进一步明确.本研究旨在评估抑郁症在接受MIS治疗后ASD患者康复中的作用。
方法:接受ASDMIS且术后至少随访1年的患者,多中心注册表。确定了两组患者,其中包括在术前评估中确认或否认抑郁症的患者。比较的患者报告结果指标(PROMs)包括Oswestry残疾指数(ODI)的得分,背部和腿部疼痛的数字评定量表(NRS),脊柱侧弯研究学会结果问卷(SRS-22),SF-36物理组件摘要,SF-36精神成分摘要(MCS),EQ-5D,和EQ-5D视觉模拟量表。
结果:147例患者中有27例(18.4%)术前抑郁筛查呈阳性。非抑郁队列平均融合4.83个水平,抑郁队列的每个患者融合了5.56个水平(p=0.267).在1年的随访中,10名患者仍报告抑郁症,减少了63%。术后,这两个队列都证明了他们的PROM有所改善;然而,在1年的随访中,根据EQ-5D,没有抑郁症的人在统计学上有更好的结果,MCS,和SRS-22评分(p<0.05)。在1年的随访中,抑郁症患者的NRS腿评分继续较高(3.63vs2.22,p=0.018)。在控制协变量后,作者发现抑郁症仅对1年的MCS评分有显著影响(β=8.490,p<0.05)。
结论:抑郁和非抑郁患者在MIS手术后报告了相似的改善,除了非抑郁患者的MCS评分更有可能改善.
OBJECTIVE: Depression has been implicated with worse immediate postoperative outcomes in adult spinal deformity (ASD) correction, yet the specific impact of depression on those patients undergoing minimally invasive surgery (MIS) requires further clarity. This study aimed to evaluate the role of depression in the recovery of patients with ASD after undergoing MIS.
METHODS: Patients who underwent MIS for ASD with a minimum postoperative follow-up of 1 year were included from a prospectively collected, multicenter registry. Two cohorts of patients were identified that consisted of either those affirming or denying depression on preoperative assessment. The patient-reported outcome measures (PROMs) compared included scores on the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back and leg pain, Scoliosis Research Society Outcomes Questionnaire (SRS-22), SF-36 physical component summary, SF-36 mental component summary (MCS), EQ-5D, and EQ-5D visual analog scale.
RESULTS: Twenty-seven of 147 (18.4%) patients screened positive for preoperative depression. The nondepressed cohort had an average of 4.83 levels fused, and the depressed cohort had 5.56 levels fused per patient (p = 0.267). At 1-year follow-up, 10 patients still reported depression, representing a 63% decrease. Postoperatively, both cohorts demonstrated improvement in their PROMs; however, at 1-year follow-up, those without depression had statistically better outcomes based on the EQ-5D, MCS, and SRS-22 scores (p < 0.05). Patients with depression continued to experience higher NRS leg scores at 1-year follow-up (3.63 vs 2.22, p = 0.018). After controlling for covariates, the authors found that depression significantly impacted only 1-year follow-up MCS scores (β = 8.490, p < 0.05).
CONCLUSIONS: Depressed and nondepressed patients reported similar improvements after MIS surgery, except MCS scores were more likely to improve in nondepressed patients.