Combined depression and anxiety influence patient-reported outcomes after lumbar fusion

Dhruv K.C. Goyal*, Justin D. Stull, Srikanth N. Divi, Matthew S. Galtta, Daniel R. Bowles, Kristen J. Nicholson, I. David Kaye, Barrett I. Woods, Mark F. Kurd, Kris E. Radcliff, Jeffrey A. Rihn, D. Greg Anderson, Alan S. Hilibrand, Christopher K. Kepler, Alexander R. Vaccaro, Gregory D. Schroeder

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Currently, no studies have assessed what effect the presence of both anxiety and depression may have on patient-reported outcome measurements (PROMs) compared to patients with a single or no mental health diagnosis. Methods: Patients undergoing 1- to 3-level lumbar fusion at a single academic hospital were retrospectively queried. Anyone with depression and/or anxiety was identified using an existing clinical diagnosis in the medical chart. Patients were separated into 3 groups: no depression or anxiety (NDA), depression or anxiety alone (DOA), and combined depression and anxiety (DAA). Absolute PROMs, recovery ratios, and the percentage of patients achieving minimal clinically important difference (% MCID) between groups were compared using univariate and multivariate analysis. Results: Of the 391 patients included in the cohort, 323 (82.6%) were in the NDA group, 37 (9.5%) in the DOA group, and 31 (7.9%) in the DAA group. Patients in the DAA group had significantly worse outcome scores before and after surgery with respect to Short Form-12 mental component score (MCS-12) and Oswestry Disability Index (ODI) scores (P,.001); however, the change in PROMs, recovery ratio, % MCID were not found to be significantly different between groups. Using multivariate analysis, the DAA group was found to be an independent predictor of worse improvement in MCS-12 and ODI scores (P ¼ .026 and P ¼ .001, respectively). Conclusions: Patients with combined anxiety and depression fared worse with respect to disability before and after surgery compared to patients with a single diagnosis or no mental health diagnosis; however, there were no significant differences in recovery ratio or % MCID. Level of Evidence: 3. Clinical Relevance: Combined anxiety and depression may predict less improvement in MCS-12 and ODI after lumbar arthrodesis compared with single or no mental health diagnosis.

Original languageEnglish (US)
Pages (from-to)234-242
Number of pages9
JournalInternational Journal of Spine Surgery
Issue number2
StatePublished - Apr 1 2021
Externally publishedYes


  • Anxiety
  • Arthrodesis
  • Depression
  • Fusion
  • HRQOL outcome scales
  • Lumbar
  • MCS-12
  • Mental health
  • ODI
  • PCS-12
  • PROMs
  • SF-12
  • VAS back
  • VAS leg

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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