• Lindsay Tetreault, Narihito Nagoshi, Hiroaki Nakashima, Anoushka Singh, Branko Kopjar, Paul Arnold, and Michael G Fehlings.
• *Toronto Western Hospital, Division of Neurosurgery, Toronto, Ontario, Canada †University of Toronto, Department of Surgery, Toronto, Ontario, Canada ‡Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan §Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan ¶University of Washington, Department of Health Services, Seattle, Washington, USA ||University of Kansas, Department of Neurosurgery, Kansas City, Kansas, USA.
• Spine. 2016 Jul 7.

Study DesignAnalysis of a combined prospective dataset.ObjectiveTo compare clinical outcomes in patients with and without preexisting depression or bipolar disorder undergoing surgery for degenerative cervical myelopathy (DCM).Summary Of Background DataPsychiatric co-morbidities, including depression, have been associated with worse clinical outcomes following lumbar spine surgery; however, it is unclear whether these psychiatric disorders are also predictive of outcomes in patients undergoing surgery for the treatment of DCM.MethodsFour hundred and one patients with symptomatic DCM were enrolled in the prospective AOSpine International or North America study at twelve North American sites. Patients were evaluated preoperatively and at 6-, 12- and 24-months using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short- Form 36v2 (SF-36) Health Survey. A mixed model analytic approach was used to evaluate differences in outcomes at 24-months between patients with and without psychiatric disorders, while controlling for relevant baseline characteristics and surgical factors.ResultsNinety-seven patients (24.19%) were diagnosed with preexisting depression or bipolar disorder. There were more females (65.98%) with these psychiatric disorders than males (34.02%) (p < 0.0001). Patients with psychiatric co-morbidities were more likely to have cardiovascular (p = 0.0177), respiratory (p < 0.0001), gastrointestinal (p < 0.0001), rheumatologic (p = 0.0109) and neurologic (p = 0.0309) disorders. At 24-months following surgery, patients in both groups demonstrated significant improvements on the mJOA, Nurick, NDI and SF-36 Physical Component Score (PCS). Patients with depression or bipolar disorder, however, did not exhibit a significant or clinically important change on the SF-36 Mental Component Score (MCS). There were no differences in mJOA and Nurick scores at 24-months between patients in each group. Improvement in NDI, SF-36 PCS and MCS, however, were smaller in patients with depression or bipolar disorder than those without.ConclusionsPatients with depression or bipolar disorder have smaller functional and quality of life improvements following surgery compared to patients without psychiatric co-morbidities.

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