David Bellut
Objective: Low Back Pain (LBP) is common and surgical treatment for LBP can fail for many different reasons, one being depressive symptoms and anxiety contributing to persistent symptoms. We prospectively analyzed Cortisol plasma levels and depressive symptoms on outcome regarding pain and quality of life after instrumented fusion.
Methods: Patients (n=50) underwent instrumented fusion for LBP. Before surgery, patients completed the Beck Depression Inventory (BDI) and the Core Outcome Measures Index (COMI). Demographic variables and history of depressive symptoms were noted and blood plasma cortisol measured. Outcome was evaluated at 3 and 12 months’ follow-up.
Results: There was a significant postoperative improvement in mean COMI total score and subscores. There was no association between preoperative cortisol levels and either depressive symptoms or clinical outcome. Preoperative BDI uniquely explained 6% variance in quality of life 12 months after surgery. Depressive symptoms correlated significantly with pre and postoperative symptoms of back pain, but not leg pain.
Conclusion: In this group of patients, higher scores for depression were identified as a negative predictor of quality of life 12 months postoperatively, independent of back pain and leg pain at 12 months. Depressive symptoms correlated significantly with pre and postoperative symptoms of back pain, but not leg pain. The present study highlights the importance of assessing psychological measures in this patient group to provide better clinical management before or alongside surgical treatment.
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