Prospective Study of the Assessment of Anxiety Symptoms after Minimally Invasive Lumbar Decompression

Summary

Objective To analyze associations between anxiety and postsurgical clinical outcomes in patients who underwent minimally invasive lumbar decompression surgery in addition to comparing symptoms of anxiety and depression before and after surgery.

Methods This prospective cohort study of patients who underwent minimally invasive lumbar decompression surgery. Clinical outcomes were measured before and 6 months after surgery using the Visual Analog Scale (VAS), Global Perceived Effect of Change (GPE), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). Based on the presurgical anxiety score, patients were categorized into anxious and non-anxious patients, and the outcomes were compared.

Results The patients of both groups obtained similar results concerning the clinical outcomes evaluated. Preoperative HADS scores decreased significantly 6 months after surgery in both anxiety (8.70 ± 3.48 vs. 5.75 ± 3.91) and depression (6.95 ± 3.54 vs. 5.50 ± 2.99). The VAS scale for the back (-2.8 ± 3.64) and legs (-5.5 ± 3.5) showed a reduction in pain.

Conclusion Minimally invasive lumbar decompression surgery promoted clinical and functional improvement, not being affected by preoperative anxiety symptoms. Mental health indicators showed a significant reduction in symptoms 6 months after surgery.

Keywords

anxiety - depression - estenosis - minimally invasive surgical procedures - spine

• Referências

• 1 Casey E. Natural history of radiculopathy. Phys Med Rehabil Clin N Am 2011; 22 (01) 1-5
• 2 Foley KT, Lefkowitz MA. Advances in minimally invasive spine surgery. Clin Neurosurg 2002; 49: 499-517
• 3 Boukebir MA, Berlin CD, Navarro-Ramirez R. et al. Ten-Step Minimally Invasive Spine Lumbar Decompression and Dural Repair Through Tubular Retractors. Oper Neurosurg (Hagerstown) 2017; 13 (02) 232-245
• 4 Ruetten S, Komp M, Merk H, Godolias G. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine 2009; 10 (05) 476-485
• 5 Phan K, Mobbs RJ. minimally invasive versus open laminectomy for lumbar stenosis: A systematic review and meta-analysis. Spine 2016; 41 (02) E91-E100
• 6 Anderson DG, Patel A, Maltenfort M. et al. Lumbar decompression using a traditional midline approach versus a tubular retractor system: comparison of patient-based clinical outcomes. Spine 2011; 36 (05) E320-E325
• 7 Hooten WM. Chronic pain and mental health disorders: Shared neural mechanisms, epidemiology, and treatment. Mayo Clin Proc 2016; 91 (07) 955-970
• 8 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 9 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
• 10 Delgado DA, Lambert BS, Boutris N. et al. Validation of Digital Visual Analog Scale Pain Scoring With a Traditional Paper-based Visual Analog Scale in Adults. J Am Acad Orthop Surg Glob Res Rev 2018; 2 (03) e088
• 11 Costa LO, Maher CG, Latimer J. et al. Clinimetric testing of three self-report outcome measures for low back pain patients in Brazil: which one is the best?. Spine 2008; 33 (22) 2459-2463
• 12 Marcolino JA, Mathias LA, Piccinini Filho L, Guaratini AA, Suzuki FM, Alli LA. Hospital Anxiety and Depression Scale: a study on the validation of the criteria and reliability on preoperative patients. Rev Bras Anestesiol 2007; 57 (01) 52-62
• 13 Vigatto R, Alexandre NM, Correa Filho HR. Development of a Brazilian Portuguese version of the Oswestry Disability Index: cross-cultural adaptation, reliability, and validity. Spine 2007; 32 (04) 481-486
• 14 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (06) 361-370
• 15 Lewandrowski KU, Soriano-Sánchez JA, Zhang X. et al. Regional variations in acceptance, and utilization of minimally invasive spinal surgery techniques among spine surgeons: results of a global survey. J Spine Surg 2020; 6 (Suppl. 01) S260-S274
• 16 Kim KT, Lee SH, Suk KS, Bae SC. The quantitative analysis of tissue injury markers after mini-open lumbar fusion. Spine 2006; 31 (06) 712-716
• 17 Burton AK, Balagué F, Cardon G. et al; COST B13 Working Group on Guidelines for Prevention in Low Back Pain. Chapter 2. European guidelines for prevention in low back pain : November 2004. Eur Spine J 2006; 15 (Suppl 2): S136-S168
• 18 Gotfryd AO, Valesin Filho ES, Viola DC. et al. Analysis of epidemiology, lifestyle, and psychosocial factors in patients with back pain admitted to an orthopedic emergency unit. Einstein (Sao Paulo) 2015; 13 (02) 243-248
• 19 Demyttenaere K, Heirman E. The blurred line between anxiety and depression: hesitations on comorbidity, thresholds and hierarchy. Int Rev Psychiatry 2020; 32 (5-6): 455-465
• 20 Held U, Burgstaller JM, Deforth M, Steurer J, Pichierri G, Wertli MM. Association between depression and anxiety on symptom and function after surgery for lumbar spinal stenosis. Sci Rep 2022; 12 (01) 2821
• 21 Ma XL, Zhao XW, Ma JX, Li F, Wang Y, Lu B. Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trials. Int J Surg 2017; 44: 329-338