PMID- 27541847 OWN - NLM STAT- MEDLINE DCOM- 20170217 LR - 20220409 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 26 IP - 1 DP - 2017 Jan TI - Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up. PG - 116-124 LID - 10.3171/2016.5.SPINE151428 [doi] AB - OBJECTIVE Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function. METHODS A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up. Patients were grouped by their 36-Item Short Form Health Survey mental component summary (MCS) and physical component summary (PCS) scores. Both groups had PCS scores /= 75th percentile. RESULTS Of the 264 patients (72.3%) with a 2-year follow-up, 104 (28.5%) met the inclusion criteria for LMH and 40 patients (11.0%) met those for HMH. The LMH group had a significantly higher overall rate of comorbidities, specifically leg weakness, depression, hypertension, and self-reported neurological and psychiatric disease processes, and were more likely to be unemployed as compared with the HMH group (p < 0.05 for all). The 2 groups had similar 2-year postoperative improvements in HRQOL (p > 0.05) except for the greater improvements in the MCS and the Scoliosis Research Society-22r questionnaire (SRS-22r) mental domain (p < 0.05) in the LMH group and greater improvements in PCS and SRS-22r satisfaction and back pain domains (p < 0.05) in the HMH group. The LMH group had a higher rate of reaching a minimal clinically important difference (MCID) on the SRS-22r mental domain (p < 0.01), and the HMH group had a higher rate of reaching an MCID on the PCS and SRS-22r activity domain (p < 0.05). On multivariable logistic regression, having LMH was a significant independent predictor of failure to reach an MCID on the PCS (p < 0.05). At the 2-year postoperative follow-up, 14 LMH patients (15.1%) were categorized as HMH. Two LMH patients (2.2%), and 3 HMH patients (7.7%) transitioned to a PCS score >/= 75th percentile for age- and sex-matched US norms (p < 0.01). CONCLUSIONS While patients with poor mental and physical health, according to their MCS and PCS scores, have higher medical comorbidity and unemployment rates, they still demonstrate significant improvements in HRQOL measurements postoperatively. Both LMH and HMH patient groups demonstrated similar improvements in most HRQOL domains, except that the LMH patients had difficulties in obtaining improvements in the PCS domain. FAU - Bakhsheshian, Joshua AU - Bakhsheshian J AD - Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles. FAU - Scheer, Justin K AU - Scheer JK AD - University of California, San Diego, School of Medicine. FAU - Gum, Jeffrey L AU - Gum JL AD - Norton Leatherman Spine Center, Louisville, Kentucky. FAU - Hostin, Richard AU - Hostin R AD - Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas. FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York. FAU - Bess, Shay AU - Bess S AD - Rocky Mountain Hospital for Children, Denver, Colorado. FAU - Protopsaltis, Themistocles S AU - Protopsaltis TS AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York. FAU - Burton, Douglas C AU - Burton DC AD - Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas. FAU - Keefe, Malla Kate AU - Keefe MK AD - Department of Neurological Surgery, University of California, San Francisco, California. FAU - Hart, Robert A AU - Hart RA AD - Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon; and. FAU - Mundis, Gregory M Jr AU - Mundis GM Jr AD - Scripps Health, La Jolla. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia. FAU - Schwab, Frank AU - Schwab F AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York. FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia. FAU - Ames, Christopher P AU - Ames CP AD - Department of Neurological Surgery, University of California, San Francisco, California. CN - International Spine Study Group LA - eng PT - Journal Article PT - Multicenter Study DEP - 20160819 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Comorbidity MH - Databases, Factual MH - Female MH - Follow-Up Studies MH - Humans MH - Likelihood Functions MH - Logistic Models MH - Male MH - *Mental Health/statistics & numerical data MH - Middle Aged MH - Multivariate Analysis MH - Prospective Studies MH - Quality of Life MH - Retrospective Studies MH - Severity of Illness Index MH - Spinal Curvatures/*epidemiology/physiopathology/*psychology/surgery MH - Time Factors OTO - NOTNLM OT - ASA = American Society of Anesthesiologists OT - ASD = adult spinal deformity OT - BMI = body mass index OT - DRAM = Distress and Risk Assessment Method OT - EBL = estimated blood loss OT - HMH = high mental health OT - HRQOL OT - HRQOL = health-related quality of life OT - LL = lumbar lordosis OT - LMH = low mental health OT - LOS = length of hospital stay OT - MCID = minimal clinically important difference OT - MCS = mental component summary OT - NRS = numeric rating scale OT - ODI = Oswestry Disability Index OT - PCS = physical component summary OT - PI = pelvic incidence OT - PT = pelvic tilt OT - SF-36 = 36-Item Short Form Health Survey OT - SRS-22r = Scoliosis Research Society-22r questionnaire OT - SVA = sagittal vertical axis OT - TK = thoracic kyphosis OT - adult spinal deformity OT - health-related quality of life OT - mental health OT - outcomes OT - sagittal alignment OT - sagittal vertical axis EDAT- 2016/08/20 06:00 MHDA- 2017/02/18 06:00 CRDT- 2016/08/20 06:00 PHST- 2016/08/20 06:00 [pubmed] PHST- 2017/02/18 06:00 [medline] PHST- 2016/08/20 06:00 [entrez] AID - 10.3171/2016.5.SPINE151428 [doi] PST - ppublish SO - J Neurosurg Spine. 2017 Jan;26(1):116-124. doi: 10.3171/2016.5.SPINE151428. Epub 2016 Aug 19.