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Physical and Psychological Comorbidity Independently Associated With Spine-Related Disability

Mancuso, Carol A., MD; Stal, Marina, MA; Duculan, Roland, MD; Girardi, Federico P., MD

doi: 10.1097/BRS.0000000000000569
Health Services Research

Study Design. Cross sectional analysis of patient-reported spine-related disability and comorbidity.

Objective. To 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 Data. The 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.

Methods. Several 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.

Results. Mean 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.

Conclusion. Psychological 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 Evidence: 2

Patients with psychological and major physical comorbidity have worse patient-reported cervical and lumbar spine-related disability. This study used a standard index to measure and quantify nonorthopedic physical comorbidity. The relationship between physical comorbidity and disability was independent of psychological comorbidity.

From the Hospital for Special Surgery, Weill Cornell Medical College, New York, NY.

Address correspondence and reprint requests to Carol A. Mancuso, MD, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th St, New York, NY 10021; E-mail:

Acknowledgment date: April 21, 2014. Revision date: July 17, 2014. Acceptance date: July 28, 2014.

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, royalties, stocks, grants.

© 2014 by Lippincott Williams & Wilkins