Jennifer M. Hah, Shana C. Levine, Saneel Khairnar, Luke Pirrotta, Alma Rechav Ben-Natan, Emily Tse, Gabrielle Hettie, Todd Alamin, Anand Veeravagu, Serena Hu, Tina Hernandez-Boussard
Neurospine 2025;22(2):451-464. Published online June 30, 2025
Objective Preoperative opioid misuse is associated with worse postoperative outcomes. This prospective longitudinal cohort study evaluated the association between preoperative opioid misuse and prolonged pain and opioid use after elective spine surgery; and examined postoperative trajectories of patient-reported outcomes over one year.
Methods Fifty-two patients undergoing elective spine surgery completed presurgical and weekly postoperative longitudinal assessments of pain and opioid use and monthly assessments of depression, anxiety, sleep disturbance, and physical function. Cox regression analyzed the effect of preoperative opioid misuse on time to pain and opioid cessation while linear mixed-effects models examined longitudinal changes in postoperative outcomes.
Results Adjusting for age, sex, operative region, number of spinal levels, and any preoperative opioid use, preoperative opioid misuse (COMM-Positive) was associated with a delayed return to baseline opioid dose (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.14–0.88; p=0.02) and delayed opioid cessation (HR, 0.25; 95% CI, 0.09–0.59; p=0.008). All patients experienced comparable reductions in current and average pain intensity, and pain interference over time. COMM-Positive patients reported a normalization of postoperative anxiety and depression 1 month after surgery with a rebound at 3 months while patients without preoperative opioid misuse remained stable over time.
Conclusion Preoperative opioid misuse is a significant risk factor for delayed opioid cessation even after adjusting for preoperative opioid use, and is associated with a transient normalization of anxiety and depressive symptoms with a rebound 3 months following spine surgery. Targeted screening and risk reduction strategies are needed for patients reporting preoperative opioid misuse before spine surgery.
Objective The Patient Health Questionnaire-9 (PHQ-9) is a screening tool for evaluating depressive symptoms. Research is scarce regarding the validity and correlation of PHQ-9 scores with other patient-reported outcomes of mental health after minimally invasive lumbar discectomy (MIS LD). We aim to validate PHQ-9 as a metric for assessing mental health in MIS LD patients.
Methods A database was retrospectively reviewed for patients who underwent elective, single-level MIS LD. Patients were excluded if they had incomplete preoperative PHQ-9, 12-item Short Form Health Survey (SF-12), or Veterans RAND 12-item health survey (VR12). Survey scores were collected preoperatively and postoperatively through 1 year. Mean scores were used to calculate postoperative improvement from preoperative scores. Correlation of PHQ-9 with SF-12 mental composite score (MCS) and VR-12 MCS scores was also calculated. Correlation strength was assessed by the following categories: 0.1 ≤ |r| < 0.3 = low; 0.3 ≤ |r| < 0.5 = moderate; |r| ≥ 0.5 = strong.
Results A total of 239 patients underwent single-level MIS LD. PHQ-9, VR-12 MCS, and SF-12 MCS all demonstrated statistically significant increases from preoperative scores at all postoperative timepoints (p ≤ 0.001). SF-12 MCS and VR-12 MCS were each observed to have strong and significant correlations with PHQ-9 at all timepoints when evaluated with both Pearson correlation coefficients and partial correlation coefficients.
Conclusion We observed that PHQ-9, SF-12 MCS and VR-12 MCS all significantly improve following lumbar discectomy and that PHQ-9 scores strongly correlated with these previously established measures. Our results substantiate evidence from other surgical fields that PHQ-9 scores are a valid tool to evaluate pre- and postsurgical depressive symptoms.
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Objective There is a scarcity of research evaluating gender differences in depressive symptoms among patients undergoing cervical surgery. This study investigated gender differences with regard to depressive symptom severity, measured by Patient Health Questionnaire-9 (PHQ-9), in patients following anterior cervical discectomy and fusion (ACDF) or artificial disc replacement (ADR).
Methods A prospectively maintained surgical registry was retrospectively reviewed for eligible spine surgeries. Depressive symptom severity was evaluated by PHQ-9 at both preand postoperative timepoints (e.g. , 6 weeks, 12 weeks, 6 months, 1 year, and 2 years). A chi-square test and Student t-test evaluated differences between the gender for demographic and operative variables where appropriate. Differences between the gender subgroup mean PHQ-9 scores were assessed using a t-test pre- and postoperatively (e.g. , 6 weeks, 12 weeks, 6 months, and 1 year) and a paired t-test was used to assess differences from preoperative scores at each postoperative time point.
Results A total of 170 subjects underwent 125 ACDFs and 45 ADRs. Both pre- and postoperative timepoints demonstrated no significant differences between mean PHQ-9 scores by gender. Female patients demonstrated statistically significant improvement in PHQ-9 scores at 6 weeks, and 12 weeks, but not through 2 years. Male patients demonstrated statistically significant improvement in PHQ-9 scores at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years.
Conclusion Although there were no significant differences between mean PHQ-9 score between the genders, there was a difference in magnitude of improvement. Females had a significant improvement in depressive symptom severity over baseline at the 6- and 12-week timepoints only, whereas males had significant improvement through 2 years postoperatively.
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