• Bassel G Diebo, Joshua D Lavian, Shian Liu, Neil V Shah, Daniel P Murray, George A Beyer, Frank A Segreto, Fenizia Maffucci, Gregory W Poorman, Denis Cherkalin, Barrett Torre, Dennis Vasquez-Montes, Hiroyuki Yoshihara, Daniel Cukor, Qais Naziri, Peter G Passias, and Carl B Paulino.
• Department of Orthopedic Surgery, State University of New York, Downstate Medical Center, Brooklyn, NY.
• Spine. 2018 Nov 1; 43 (21): 1455-1462.

Study DesignRetrospective analysis.ObjectiveTo improve understanding of the impact of comorbid mental health disorders (MHDs) on long-term outcomes following cervical spinal fusion in cervical radiculopathy (CR) or cervical myelopathy (CM) patients.Summary Of Background DataSubsets of patients with CR and CM have MHDs, and their impact on surgical complications is poorly understood.MethodsPatients admitted from 2009 to 2013 with CR or CM diagnoses who underwent cervical surgery with minimum 2-year surveillance were retrospectively reviewed using New York State's Statewide Planning and Research Cooperative System. Patients with a comorbid MHD were compared against those without (no-MHD). Univariate analysis compared demographics, complications, readmissions, and revisions between MHD and no-MHD cohorts. Multivariate binary logistic regression models identified independent predictors of outcomes (covariates: age, sex, Charlson/Deyo score, and surgical approach).ResultsA total of 20,342 patients (MHD: n = 4819; no-MHD: n = 15,523) were included. MHDs identified: depressive (57.8%), anxiety (28.1%), sleep (25.2%), and stress (2.9%). CR patients had greater prevalence of comorbid MHD than CM patients (P = 0.015). Two years postoperatively, all patients with MHD had significantly higher rates of complications (specifically: device-related, infection), readmission for any indication, and revision surgery (all P < 0.05); regression modeling corroborated these findings and revealed combined surgical approach as the strongest predictor for any complication (CR, odds ratio [OR]: 3.945, P < 0.001; CM, OR: 2.828, P < 0.001) and MHD as the strongest predictor for future revision (CR, OR: 1.269, P = 0.001; CM, OR: 1.248, P = 0.008) in both CR and CM cohorts.ConclusionNearly 25% of patients admitted for CR and CM carried comorbid MHD and experienced greater rates of any complication, readmission, or revision, at minimum, 2 years after cervical spine surgery. Results must be confirmed with retrospective studies utilizing larger national databases and with prospective cohort studies. Patient counseling and psychological screening/support are recommended to complement surgical treatment.Level Of Evidence3.

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