engleski

Influence of depression on patients&#8217 ; satisfaction with the outcome of microsurgical &#8220 ; keyhole&#8221 ; or classic discectomy: A matched-cohort study

BACKGROUND. Lumbar discectomy, although considered as the most optimistic part of neurological surgery, is connected with an unacceptably high unsuccessful outcome rate, up to 60%. Three mortal sins responsible for failed back surgery that surgeons admit are: doing the wrong operation, doing the correct operation at the wrong level, and operating on the wrong patients. AIM. To assess influence of depression to the patients&#8217 ; satisfaction with two different lumbar discectomy surgical techniques. METHODS. A matched-cohort analysis of classic lumbar discectomy following static imaging (N= 45) and microlumbar &#8220 ; key-hole&#8221 ; discectomy after dynamic CT/myelography (N= 55) was performed. The outcome was independently assessed using Prolo activity (E) and pain (F) scale, and depressiveness according to Hamilton rating scale. Patients without improvement on Prolo scale were classified as failed back surgery syndrome, and with a Hamilton score 17 or more, as depressive. RESULTS. The groups were well matched by age, sex, clinical presentation and incidence of depression. In the &#8220 ; key-hole&#8221 ; group, both activity and pain outcome was better than in the classic technique group (median E score (range) = 4 (2-5) vs. 3 (2-4), p=0.002, median F score (range) = 4 (2-5) vs. 4 (1-5), p=0.008). Eighteen patients were classified as failed back syndrome, 6 in the &#8220 ; key-hole&#8221 ; group, and 12 in the classic group (z=3.16, p=0.075). Incidence of failed back syndrome among non-depressive patients was significantly lower in &#8220 ; key-hole&#8221 ; group (2/55 patients vs. 8/45, z=2.345, p=0.009). Occurrence of unsatisfactory results among depressive patients was very similar in both groups (4/55 patients vs. 4/45, z=0.296, p=0.384). CONCLUSIONS. Introduction of functional imaging and &#8220 ; key-hole&#8221 ; technique decreased incidence of failed back syndrome among non-depressive patients. Unsatisfactory outcome among depressive patients was unrelated to the imaging and surgical technique. Connection between depression and failed back syndrome, although detected, remains unclear and must be further investigated. Results of the study suggest that preoperative work up of the patients with low back pain should include Hamilton and/or Beck depression rating scale.

depression; discectomy; outcome assessment; spine; quality of life; lumbosacral region; myelography

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