EFFECT OF ELECTIVE CERVICAL SPINE SURGERY ON MENTAL HEALTH OF PATIENTS WITH DEGENERATIVE CERVICAL MYELOPATHY (DCM): A CSORN STUDY

The objective of this investigation is to evaluate whether enhancements in health-related quality of life (HRQOL), consequent to efficacious cervical spine surgery in individuals diagnosed with degenerative cervical myelopathy (DCM), lead to improvements in mental health metrics. The primary outcome assessed was the change between the preoperative and postoperative SF12 Mental Component Score (MCS) alongside the modified Japanese Orthopedic Association (mJOA) scores. Secondary outcomes include SF-12 Physical Component Score (PCS), EQ-5D, Neck Disability Index (NDI), Patient Health Questionaire-9 (PHQ9), and neck pain scale.The Canadian Spine Outcome Research Network registry was queried for all patients who received surgery for DCM with ≥12-month follow-up. Exclusion criteria were trauma, tumor, infection, and previous spine surgery. Patients were categorized into six distinct cohorts based on their SF-12 MCS (pre-operative presence or absence of depression) and mJOA (mild, moderate, or severe DCM). SF12 Mental Component Scores (MCS) were compared between those with and without significant improvement (reaching Minimally Clinically Important Differences (MCID)) for mJOA and between disease severity groups. Multivariate analysis examined factors predictive of MCS improvement. 22 hospitals contributed 500 eligible patients. There was a greater significant improvement in MCS and NDI 12-months post-op across all cohorts in the depressed cohort more than in their respective non-depressed cohorts. Patients exceeding MCID in mJOA had the greatest improvements in MCS regardless of disease severity. Major depression prevalence decreased by 43% following the degenerative cervical myelopathy surgery. Of all the factors studied, sole the presence of depression pre-operatively is predictive of improved MCS post-operatively with an odd ration of 4. Our data suggests that successful surgery for DCM is associated with improvement of MCS and decrease in prevalence of major depression, and this decrease in was more pronounced in patients with pre-operative depression regardless the severity of DCM.