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Depressive Burden in the Preoperative and Early Recovery Phase Predicts Poorer Surgery Outcome Among Lumbar Spinal Stenosis Patients: A One-Year Prospective Follow-up Study

Sinikallio, Sanna, PhD*; Aalto, Timo, MD†‡; Airaksinen, Olavi, DMSc; Herno, Arto, DMSc; Kröger, Heikki, DMSc§; Viinamäki, Heimo, DMSc

doi: 10.1097/BRS.0b013e3181b317bd
Health Services Research

Study Design. Prospective clinical study.

Objective. (1) To determine the prevalence of depression at the 1-year postoperative stage among spinal stenosis patients. (2) To assess the predictive value of preoperative and 3-month depressive symptoms regarding the 1-year surgery outcome.

Summary of Background Data. Some studies have found preoperative depressive symptoms to be associated with a poorer spinal stenosis surgery outcome. However, only the effect of preoperative depressiveness has been evaluated. The prevalence of depressiveness on 1-year follow-up among spinal stenosis patients is unclear.

Methods. One hundred two patients (mean age, 62 years) with symptomatic lumbar spinal stenosis underwent decompressive surgery. They completed the same set of questionnaires before surgery, 3 months, and 1 year after surgery. Depression was assessed with the 21-item Beck Depression Inventory. Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability, the visual analogue scale and pain drawing. Logistic regression was used to examine the preoperative factors associated with a poorer surgery outcome on 1-year follow-up. In further analysis, a depressive burden variable (sum of preoperative and 3-month Beck Depression Inventory scores) was included as a predictor.

Results. Eighteen percent of spinal stenosis patients were depressed on 1-year follow-up. Higher preoperative Beck Depression Inventory scores and depressive burden scores burden were independently associated with a poorer self-reported functional ability, symptom severity and a poorer walking capacity on 1-year follow-up. As a dichotomous predictor, a high depressive burden was independently associated with all the postoperative outcome variables at the 1-year stage: greater disability, pain and symptom severity, and a poorer walking capacity.

Conclusion. The prevalence of depression was notable among 1-year postoperative spinal stenosis patients. Depressive symptoms in the preoperative and early recovery phase were strong predictors of a poorer self-reported surgery outcome on 1-year follow-up. The results call for intervention strategies to detect and treat depression during both the preoperative and postoperative phase.

A prospective study was conducted to determine the prevalence of postoperative depression and the predictive value of preoperative and 3-month depressiveness regarding the 1-year surgery outcome for spinal stenosis. One hundred two patients completed self-reports of depression, pain and disability. Depressive symptoms were strong predictors of a poorer 1-year surgery outcome.

From the *Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland; †Kyyhkylä Rehabilitation Center, Mikkeli, Finland; ‡Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland; §Department of Orthopaedics and Traumatology, Kuopio University Hospital and Bone and Cartilage Research Unit, Kuopio University, Kuopio, Finland; and ¶Department of Psychiatry of Kuopio University and Kuopio University Hospital, Kuopio, Finland.

Acknowledgment date: November 3, 2008. First revision date: April 9, 2009. Acceptance date: April 9, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by a Kuopio University Hospital EVO research grant and a research grant from the Signe and Ane Gyllenberg foundation (to S.S.).

Approved by the Ethics Committee of the University of Kuopio and Kuopio University Hospital, Finland.

Address correspondence and reprint requests to Sanna Sinikallio, PhD, Kuopio University Hospital, Department of Rehabilitation (2981), Tarinan sairaala, FI-71800 Siilinjärvi, Finland; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.