Objective:

To evaluate impact of preoperative mental health on expectations among patients undergoing transforaminal, anterior, or lateral lumbar interbody fusion (TLIF/ALIF/LLIF).

Methods:

Lumbar fusion procedures were identified. Demographics/perioperative characteristics/duration of preoperative symptoms/preoperative mental health scores were collected. Pain/disability were recorded using preoperative VAS-back/VAS-leg/ODI. Expectations were recorded. Preoperative mental health was recorded using PHQ-9/SF-12 MCS/VR-12 MCS. PHQ-9 scores were additionally categorized by severity of depressive symptoms. Baseline characteristics/preoperative mental health scores/preoperative expectations were descriptively analyzed. Simple linear regression evaluated impact of preoperative mental health on patient expectations for pain/disability; multiple linear regression evaluated the same while accounting for preoperative scores.

Results:

181 patients included. PHQ-9 and increasing severity of depressive symptoms significantly predicted VAS back expectations(p≤0.006); significance was lost after accounting for preoperative VAS back. All mental health outcomes significantly predicted VAS leg expectations(p≤0.040); only PHQ-9 retained significance after accounting for preoperative VAS leg. All mental health scores significantly predicted ODI expectations(p<0.001, all); none retained significance after accounting for preoperative ODI. PHQ/SF-12/VR-12 significantly predicted all ODI domains except personal care/pain intensity(p≤0.045, all). PHQ-9 significantly predicted patient expectations for lifting/walking/standing/sleeping/sex/social. SF-12 MCS significantly predicted expectations for lifting/walking/standing/sleeping/social after accounting for preoperative domain scores. VR-12 MCS significantly predicted lifting/walking/standing/sleeping/sex/social(p≤0.050, all), even after accounting for preoperative scores.

Conclusion:

While mental health scores significantly predicted preoperative expectations for improvement of pain/disability, sub-analysis demonstrated that mental health scores impact expectations with regards to improvement in more active areas of a patient’s life. Inferior mental health scores may associate with lower expectations for preoperative symptom improvement.