The Impact of High Depressive Burden on Outcomes After Anterior Cervical Discectomy and Fusion.

Authors

• Chloe Herczeg
• Jonathan F Dalton
• Joydeep Baidya
• Jarod Olson
• Rachel Huang
• Robert Oris
• Ali Farooqi
• Brandon Martinazzi
• William Green
• Joshua Mathew
• Yulia Lee
• Baek Gregorio
• Eric Tecce
• Ian Argento
• Ian David Kaye
• Zachary Wilt
• Mark F Kurd
• Jose A Canseco
• Alan S Hilibrand
• Alexander R Vaccaro
• Gregory D Schroeder
• Christopher Kepler
• John J Mangan

Publication/Presentation Date

7-15-2026

Abstract

STUDY DESIGN: Retrospective chart review of a single institution's ACDF patients.

OBJECTIVE: To evaluate how depressive burden impacts outcomes after anterior cervical discectomy and fusion (ACDF).

SUMMARY OF BACKGROUND DATA: Poor mental health is associated with worse outcomes after spine surgery. However, these findings are typically based on preoperative, short-form psychometric assessments. "Depressive burden" has been proposed as a more robust evaluation of mental health, which includes both preoperative and postoperative mental health patient-reported outcome measures (PROMs).

MATERIALS AND METHODS: Patients who underwent primary, elective ACDF (2014-2020) were retrospectively identified-demographic/surgical variables were evaluated via chart review. PROMs were evaluated preoperatively and at 3/6/12 months, including Visual Analog Scale (VAS) Neck/Arm, SF-12-Mental (MCS) and Physical Component Scores (PCS), Neck Disability Index (NDI), and Modified Japanese Orthopaedic Association (mJOA). Patients were excluded if they underwent ACDF for trauma/tumor/infection/revision or had inadequate PROMs. High depressive burden was defined as average preoperative and 3-month postoperative MCS scores ≤45, consistent with the literature regarding clinically relevant depression. Achievement of the minimum clinically important difference (MCID) was evaluated at 1-year postoperatively.

RESULTS: A total of 311 patients were included (93 with high depressive burden). Patients with high depressive burden were younger (55 vs . 58.6; P < 0.001) and had better Charlson Comorbidity Index (CCI) (1.35 vs . 1.68; P =0.046), but were otherwise demographically/surgically like patients without high depressive burden. Despite having similar postoperative outcomes, patients with high depressive burden had worse PROM scores at all timepoints. Patients with high depressive burden experienced greater MCS improvement (4.6 vs . 0.48; P =0.003), but worse PCS improvement (3.22 vs . 7.13; P < 0.001) at 1 year. Multivariable regression identified high depressive burden as predictive of not achieving MCID for PCS (OR: 0.34; P < 0.001) and mJOA (OR: 0.42; P < 0.001), when controlling for age, CCI, number of levels fused, socioeconomic status, and preoperative PROM.

CONCLUSIONS: ACDF patients with high depressive burden had worse 1-year PROMs across all metrics. Despite similar surgical outcomes, multivariable regression showed high depressive burden was independently predictive of not achieving MCID for PCS and mJOA.

Volume

51

Issue

14

First Page

995

Last Page

1001

ISSN

1528-1159

Published In/Presented At

Herczeg, C., Dalton, J. F., Baidya, J., Olson, J., Huang, R., Oris, R., Farooqi, A., Martinazzi, B., Green, W., Mathew, J., Lee, Y., Gregorio, B., Tecce, E., Argento, I., Kaye, I. D., Wilt, Z., Kurd, M. F., Canseco, J. A., Hilibrand, A. S., Vaccaro, A. R., … Mangan, J. J. (2026). The Impact of High Depressive Burden on Outcomes After Anterior Cervical Discectomy and Fusion. Spine, 51(14), 995–1001. https://doi.org/10.1097/BRS.0000000000005475

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

40827641

Department(s)

Administration and Leadership

Document Type

Article