Details

Autor(en) / Beteiligte

• Kim, Elliott J., MD
• Chotai, Silky, MD
• Stonko, David P., MS
• Wick, Joseph B., BA
• Schneider, Byron J., MD
• McGirt, Matthew J., MD
• Devin, Clint J., MD

Titel

Patient reported outcomes after lumbar epidural steroid injection for degenerative spine disease in depressed versus non-depressed patients

Ist Teil von

• The spine journal, 2017-04, Vol.17 (4), p.511-517

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Background Context Non-operative modalities such as lumbar epidural steroid injections (LESI) are often used in the setting of lumbar spine disorders where other conservative measures have failed. Concomitant depression can lead to worse outcomes in lumbar spine pathology. A number of studies have demonstrated an association between preoperative depression and poor outcomes following surgery but the effect of depression on outcomes following non-operative modalities is poorly understood. Purpose Evaluate the differences in patient reported outcomes (PROs) between depressed and non-depressed patients undergoing LESI Study Design/Setting Analysis of a prospective longitudinal registry database at a single academic institution Patient Sample All patients undergoing LESI from 2012 to 2014 were eligible for enrollment into a prospective, web-based registry. Eligible patients had radicular pain, correlative imaging findings of degenerative pathology, and failed 6-weeks of conservative care. Outcome Measures PROs measured included: Numeric rating scale (NRS) for (1) back and (2) leg pain; (3) disease-specific physical disability – Oswestry Disability Index (ODI); (4) preference-based health status – EuroQol-5D (EQ-5D). Methods Patients who met inclusion criteria underwent LESI. PROs were collected at baseline and 12 months following treatment. Based on previously validated values for Zung Depression Scale (ZDS) as a screening tool for depression, patients were dichotomized into non-depressed: ZDS ≤ 33 and depressed: ZDS > 33. PRO change scores from baseline to 12-months were calculated. Mean absolute and change score between the groups was compared using student t-test. Multivariable linear regression analysis for ODI, EQ-5D, NRS-LP and BP was performed. Results A total of 161 patients with complete 12-month follow-up were included. 71 (44%) were classified as depressed and 90 (56%) as non-depressed patients. The mean baseline PRO scores were significantly worse in depressed patients compared to non-depressed patients: ODI (P<0.001), NRS-back pain (P=0.013), NRS-leg pain (P<0.001), and EQ5D (P=0.001). The mean absolute scores at 12-months were significantly lower in the depressed versus non-depressed patients: ODI (P<0.001), NRS-back pain (P=0.001), NRS-leg pain (P=0.05), EQ5D (P=0.003). However, there was no difference in mean change scores observed at 12-months between the depressed and non-depressed cohorts: ODI (P=0.42), NRS-back pain (P=0.31), NRS-leg pain (P=0.25), EQ-5D (P=0.14). Adjusting for pre-procedure variables, the higher ZDS score was associated with higher disability (ODI) at 12-months. Conclusion Depression led to worse absolute scores for patient-reported outcomes and is associated with higher disability following LESI. However, patients with depressive symptoms can expect similar improvement in PROs at 12 months.