Depression Can Complicate Spinal Stenosis Surgical Outcomes

Lumbar spinal stenosis (LSS), which causes lower extremity pain in combination with back pain, usually occurs as a consequence of spinal degeneration from aging, although disc herniation, osteoporosis, and tumors are other potential causes. Non-operative therapies are usually the treatments of choice for LSS, since surgery is typically reserved for patients who fail to respond to those conservative treatments.

Among patients who do undergo surgery for LSS, depression and anxiety have been associated with poor surgical outcomes. However, the studies that contain those findings generally followed patients for only a short period of time. Interested in determining the long-term effect of depression on surgical outcomes, researchers in Finland followed LSS patients for 5 years and published their prospective observational study online Feb. 3, 2014, in The Spine Journal.

The researchers evaluated surgical outcomes in a total of 102 LSS patients. Using a questionnaire, they collected data preoperatively and at 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively.

One key finding of their study was that high depressive burden was associated with greater disability from the time of surgery, including the 5-year point. In fact, this tendency toward poorer recovery in patients with high depressive burden was evident throughout the follow-up period. The researchers said this finding confirms screening for depression is critical and needed throughout the extensive rehabilitation period after LSS surgery.

Despite their depressive symptoms, patients still experienced improved walking distance and less disability after their LSS surgery. However, only 43% of the depressed LSS patients had been prescribed an antidepressant at the 5-year mark, which yet again indicates that depression is an undertreated condition. The researchers noted that antidepressants are appropriate to treat chronic pain and could be useful in the post-surgical LSS population.