Influence of Preoperative Depression on Cervical Spine Surgery Outcomes: A Systematic Review and Meta-Analysis

Study Design: Systematic review and Meta-analysis. Objectives: To quantify the association of preoperative depression on patient reported outcome measures (PROMS) after cervical spine surgery. Methods: We systematically searched PubMed, Cochrane, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov until September 14, 2023. Studies including adults undergoing cervical spine surgery and comparing PROMs between depressed and non-depressed patients were included. The primary outcome was the postoperative change in disability, pain, and physical function. Secondary outcomes included absolute disease severity before and after surgery. We conducted random-effects meta-analysis. Results: After screening 3813 articles, 20 studies were included, encompassing 3964 patients (mean age 57, 51% males) with median follow-up duration of 12 months. There was significant heterogeneity in estimates of the primary outcome (I² = 81%). While patients with depression had a greater magnitude of improvement compared with patients without depression, it was not statistically significant (SMD = 0.04, [95% CI: −0.07, 0.16], I² = 80%; P = 0.48). However, patients with depression exhibited worse absolute disease severity preoperatively (SMD = −0.31, [-0.44, −0.19], I² = 84%; P < 0.001) and postoperatively (SMD = −0.31, [−0.48, −0.15], I² = 89%; P < 0.002). Sensitivity analyses with meta-regression found that older age, sex (male-to-female ratio), percentage of comorbidities, study quality, follow-up duration, number of adjusted factors in the analysis, and surgical approach were significant sources of heterogeneity. Conclusions: Patients with depression experienced similar improvements in disability, pain, and physical function after cervical surgery compared to patients without depression. However, patients with depression exhibited worse disease severity before and after surgery.