Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy

Abstract

Objective: Several efforts have been made to investigate the long-term efficacy of artificial disc replacement surgery compared with that of fusion after decompression for the treatment of cervical degenerative disc disease and radiculopathy. However, research on the impact of mental distress on surgical treatment outcome has been sparse. The aim of the authors was to investigate the potential predictive value of preoperative risk factors in determining long-term outcome.

Methods: A total of 153 patients (mean age 47 years) with single- or double-level cervical degenerative disc disease and radiculopathy were randomly assigned to undergo either anterior cervical discectomy and fusion (n = 70) or artificial disc replacement (n = 83). The primary outcome was the Neck Disability Index (NDI) score, a patient-reported function score that ranges from 0% to 100%; higher scores indicate greater disability. Preoperative variables such as sex, age, smoking status, employment status, having a strenuous job, neck pain duration, arm pain duration, amount of regular exercise, Hospital Anxiety and Depression Scale (HADS) score, NDI score, whether surgery was performed on 1 or 2 levels, and allocated treatment were analyzed in multiple linear regression models with the 5-year NDI score as the outcome.

Results: A total of 47 (31%) patients had either a HADS anxiety or HADS depression score of 10 points or higher. High values on the preoperative HADS were a negative predictor of outcome (p = 0.009). Treatment allocation had no effect on 5-year NDI scores (p = 0.32).

Conclusions: Preoperative mental distress measured with the HADS affects long-term outcome in surgically treated patients with cervical radiculopathy.

Keywords: ADR = artificial disc replacement; EQ-5D = EuroQol-5 Dimensions; HADS = Hospital Anxiety and Depression Scale; Hospital Anxiety and Depression Scale; ITT = intention to treat; MCID = minimum clinically important difference; NDI = Neck Disability Index; Neck Disability Index; PROM = patient-reported outcome measure; RCT = randomized controlled trial; VAS = visual analog scale; artificial disc replacement; cervical radiculopathy; treatment outcome.