(I-533) Baseline Depressive Symptoms Associated with Significant Increased Incidence of Neck, Back Pain and Intensity, Myelopathy, and Life Quality Outcomes Observed in Primary Intradural Spinal Cord Patients
Medical Student Central Michigan University College of Medicine
Introduction: The notion of clinically incorporating the evaluation of depressive status in spine patients can sometimes sound very irrelevant and impractical, especially when clinic work-up and imaging studies are directly pointing to the specific spine pathological insult(s) and indicating surgical intervention. Increasing evidence in the spine literature suggests that spine surgery patients with depressive status do poorly perioperatively.
Methods: Following Institutional Review Board (IRB) of Beijing Tiantan Hospital approval, we prospectively obtained patient data from January 2017 through December 2017. The study design included: adult patients diagnosed with primary intramedullary spinal cord tumors [ID-SCTs] who underwent surgery. The 17-itemized Hamilton Depression Rating Scale [HAM-D] questionnaire tool [Score Scale: 0 to 30 points] was utilized to evaluate depressive status in the ID-SCT patients, at baseline. Patients who scored >7 points met the criteria for depressive status (DP_ID-SCT), while those with score of ≤7 points were considered as non-depressed (NDP_ID-SCT). Baseline and 2-year postoperative clinical outcomes were analyzed by t-tests following Python-based ‘age and sex’ propensity score matching (PSM) of the [NDP_ID-SCT] and [DP_ID-SCT] patients. Significance was set at (p < 0.05).
Results: Overall, 168 patients with ID-SCTs were age- and gender-matched, [NDP_ID-SCT]; n=84 (50.0%) and [DP_ID-SCT]; n=84 (50.0%), respectively. Significantly decreased daily average sleep time of [397.54 ± 92.16] minutes was observed in the [DP_ID-SCT] group compared to an average of [423.20 ± 62.88] minutes in the [NDP_ID-SCT] group, (p < 0.05). At baseline, the incidence of intramedullary tumors was significantly higher in the [DP_ID-SCT] patient group, (p < 0.05), but no difference in W.H.O. grading. The McCormick’s grading, and the HRQoL outcomes were also significantly inferior in the [DP_ID-SCT] group, (p < 0.05) at baseline. At 2-year postoperative, the incidences of neck or back pain, myelopathy, generalized muscle weakness, paralysis (paraplegia), McCormick’s grading, radicular pain intensity, HRQoL and patient satisfaction rate outcomes significantly demonstrated inferior outcomes in the [DP_ID-SCT] patient group, (p < 0.05).
Conclusion : A baseline depressive status was significantly associated with poorer perioperative clinical, neurological, functional, and satisfactory outcome in spine patients and carries forward into 2-year postoperative neurological and physical morbidity. Baseline depressive status was consistent with significant decrease in daily average sleep time.
