Impact of Depression and Anxiety on Outcomes Following Muscle-Preserving Transforaminal Lumbar Interbody and Fusion

The impact of concurrent diagnoses of anxiety and depression has not been extensively studied in spine surgery. We hypothesize that a muscle-sparing technique may be associated with decreased postoperative pain and improved strength postoperatively compared to open techniques, decreasing the stress of the postoperative recovery process. Therefore, this study aims to assess the benefits that a modified muscle-preserving lumbar fusion technique (Wiltse transforaminal lumbar interbody and fusion (W-TLIF)) would have on this subset of patients.

One hundred twenty subjects who underwent a single-level W-TLIF were identified with a recorded diagnosis status associated with mental health. The subjects underwent surgery between January 2013 and January 2023 by the same surgeon at a single institution. Data was collected through a prospective registry and chart review. All subjects had a minimum of one-year follow-up. Mental health diagnosis, BMI, blood loss, operative duration, preoperative Short-Form 12 (SF-12) and Oswestry Disability Index (ODI) scores, and postoperative SF-12 and ODI scores were collected. Data was evaluated using SPSS version 29 (IBM Corp., Armonk, NY) and standard statistical modeling.

One hundred twenty subjects with a confirmatory mental health diagnosis who underwent a single-level muscle-sparing TLIF were identified. Eighty-seven subjects had no diagnosis, six subjects were diagnosed with anxiety, 12 subjects were diagnosed with depression, and seven subjects were diagnosed with both anxiety and depression. Preoperative SF-12 was also included for an additional eight subjects for whom data was available. The mean total SF-12 score between cohorts was 78.5, 83.3, 74.6, and 85.9, respectively. The mean preoperative mental component scores were 48.2, 36.4, 42.0, and 42.2, respectively (p=0.002). The mean ODI scores between cohorts were 34.5, 45.2, 52.9, and 44.2, respectively (p=0.002). All subjects demonstrated statistically significant improvement in total SF-12 and ODI scores. There were no statistically significant differences in achievement between cohorts. The mean blood loss was 156.5 mL, 104.2 mL, 202.5 mL, and 142.9 mL, respectively, without statistical significance.

The subjects with a concurrent diagnosis of anxiety and/or depression can experience improvement postoperatively following W-TLIF. Despite having increased levels of preoperative disability, outcomes did not significantly differ from those without a mental health diagnosis. Blood loss, while not statistically significant, did trend lower in those with a diagnosis of anxiety and may be related to lower BMI. The preoperative optimization of anxiety and depression should likely still be considered in efforts to improve outcomes and patient satisfaction.