• Carol A Mancuso, Marina Stal, Roland Duculan, and Federico P Girardi.
• From the Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.
• Spine. 2014 Nov 1;39(23):1969-74.

Study DesignCross sectional analysis of patient-reported spine-related disability and comorbidity.ObjectiveTo determine if nonorthopedic physical and psychological comorbidity are independently associated with self-reported spine-related disability in patients scheduled for spine surgery.Summary Of Background DataThe association between psychological comorbidity and spine-related disability is well known; less is known about the contribution of nonorthopedic physical comorbidity to patients' ratings of spine-related disability.MethodsSeveral days before surgery, 175 patients with cervical problems and 538 patients with lumbar problems completed the Neck Disability Index and the Oswestry Disability Index, respectively; scores range from 0% to 100%; higher scores reflect more disability. The Charlson Comorbidity Index, a standard index of weighted major physical comorbidity, was used to dichotomize patients according to no major physical comorbidity (Charlson Comorbidity Index=0) or any major physical comorbidity (Charlson Comorbidity Index≥1). Psychological comorbidity was measured for depressive symptoms and anxiety with validated scales.ResultsMean age of patients with cervical problems was 54 years, 60% were males, mean Neck Disability Index score was 44%, and 25% had major physical comorbidity. In multivariate analysis controlling for younger age (P<0.0001) and female sex (P<0.0001), more depressive symptoms (P=0.0003), and having major physical comorbidity (P=0.02) were associated with worse Neck Disability Index scores. Mean age of patients with lumbar problems was 56 years, 55% were males, mean Oswestry Disability Index score was 56%, and 30% had major physical comorbidity. In multivariate analysis controlling for younger age (P=0.36) and female sex (P=0.002), more depressive symptoms (P<0.0001), and having major physical comorbidity (P=0.03) were associated with worse Oswestry Disability Index scores.ConclusionPsychological comorbidity and nonorthopedic physical comorbidity measured by a standard index are associated with patient-reported spine-related disability in patients undergoing cervical and lumbar spine surgery. Given that disability is a major indicator for surgery, how psychological and physical comorbidity influence patients' assessment of spine-related disability merits further investigation.Level Of Evidence2.

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