Depression changes/persistence and patient satisfaction after lumbar spinal stenosis surgery: A prospective cohort study

Objectives: Lumbar spinal stenosis is a leading cause of disability worldwide. Although decompression surgery generally improves pain and function, a substantial proportion of patients remains dissatisfied. Depression is increasingly recognized as a key determinant of surgical outcomes; however, the post-operative changes and persistence of depressive symptoms and their relationship with patient satisfaction remain underexplored. This prospective study evaluated the influence of pre- and post-operative psychological status on satisfaction after lumbar decompression surgery in a Saudi Arabian cohort. Methods: In this prospective study, 139 patients undergoing lumbar decompression were assessed using Arabic versions of the Swiss Spinal Stenosis Questionnaire (SSSQ) and Patient Health Questionnaire-9. Patient satisfaction was assessed using the satisfaction subscale of the SSSQ, comprising 6 items scored 1–4 (range: 6–24), with higher scores indicating lower satisfaction. Six-month outcomes were analyzed using Wilcoxon tests, with correlation and multivariable regression used to identify predictors of satisfaction. Results: Significant post-operative improvements were observed in symptom severity (median 27 to 13), physical function (17 to 11), and depression scores (4 to 0) (all p < 0.001). The median satisfaction score was 9. On univariate analysis, higher pre-operative depression and symptom severity were associated with better post-operative satisfaction, likely reflecting greater potential for improvement; however, only baseline symptom severity remained an independent predictor in the multivariable model ( p = 0.010), while pre-operative depression did not reach significance ( p = 0.136). In contrast, persistent post-operative depression was significantly associated with worse symptom severity, impaired physical function, and lower satisfaction. Conclusion: Lumbar decompression surgery improves both physical and psychological outcomes; however, patient satisfaction is more strongly influenced by the changes and persistence of depressive symptoms than by baseline depression alone. Incorporating routine psychological screening, pre-operative counseling, and culturally tailored psychosocial support may enhance post-operative satisfaction and recovery.