Effect of Depression on Patient-Reported Outcomes Following Cervical Epidural Steroid Injection for Degenerative Spine Disease.
Publication/Presentation Date
12-1-2018
Abstract
OBJECTIVE: To assess the effect depression has on outcomes after cervical epidural steroid injections (CESIs).
DESIGN: Retrospective review of a prospectively collected database.
SETTING: Single institution tertiary care center.
SUBJECTS: Fifty-seven patients with cervical spondylosis and cervical radicular pain who were deemed appropriate surgical candidates but elected to undergo CESI first were included.
METHODS: Twenty-one of 57 (37%) patients with depression (defined as Zung Depression Scale >33) were included. Patient-reported outcomes including Neck Disability Index (NDI), numeric rating scale (NRS) for arm pain (AP), NRS for neck pain (NP), and EuroQol-5D (EQ-5D) were collected at baseline and three-month follow-up. Minimal clinically important differences were then calculated to provide dichotomous outcome measures of success.
RESULTS: Overall, 24 and 28 patients achieved at least 50% improvement in AP and NP, respectively. In terms of disability, 25/57 (43.9%) patients achieved >13.2-point improvement on the NDI overall. In patients with depression, 4/21 (19.0%) and 5/21 (23.8%) achieved at least 50% improvement on the NRS for AP and NP, respectively, compared with 20/36 (55.5%) and 23/36 (63.8%) in patients without depression. This difference was statistically significant for both pain measures (P < 0.002 AP, P < 0.006 NP). Statistically fewer patients, 5/21 (24%), with depression achieved ≥13.2-point improvement on the NDI compared with 20/36 (55%) nondepressed patients (P < 0.01). There was no difference in outcomes between groups on the EQ-5D.
CONCLUSIONS: Patients with cervical spondylosis and comorbid depression who undergo CESI are less likely to achieve successful outcomes in both pain and function compared with nondepressed patients at three months.
Volume
19
Issue
12
First Page
2371
Last Page
2376
ISSN
1526-4637
Published In/Presented At
Kim, E. J., Chotai, S., Schneider, B. J., Sivaganesan, A., McGirt, M. J., & Devin, C. J. (2018). Effect of Depression on Patient-Reported Outcomes Following Cervical Epidural Steroid Injection for Degenerative Spine Disease. Pain medicine (Malden, Mass.), 19(12), 2371–2376. https://doi.org/10.1093/pm/pny196
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
30357417
Department(s)
Administration and Leadership
Document Type
Article