DOI: 10.1097/brs.0000000000005893 ISSN: 0362-2436

Mental Health Recovery Trajectories After Surgery for Degenerative Cervical Myelopathy

Vishwathsen Karthikeyan, Nathan Evaniew, Armaan K. Malhotra, Christopher S. Lozano, Andrew Glennie, Christopher S. Bailey, David Cadotte, Zhi Wang, Supriya Singh, Philippe Phan, Jérôme Paquet, Chris Small, Andrew Nataraj, Charles G. Fisher, Michael H. Weber, Raja Rampersaud, Jefferson R. Wilson, Nicolas Dea
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Study Design.

Retrospective analysis of a multicenter, prospective observational cohort.

Objective.

To identify distinct postoperative trajectories of mental health following surgery for degenerative cervical myelopathy (DCM) and to assess the independent association between trajectory membership and 12-month patient satisfaction.

Summary of Background Data.

Although surgery improves neurological and functional outcomes for patients with DCM, its impact on mental health remains poorly characterized. Patients with DCM frequently report poor mental well-being, which may influence quality of life and satisfaction with treatment.

Methods.

We analyzed data from the ongoing Canadian Spine Outcomes Research Network (CSORN) multicenter prospective observational DCM study. Group-based trajectory modeling (GBTM) was used to identify latent MCS recovery trajectories. Logistic regression evaluated associations between trajectory group membership and 12-month satisfaction, adjusting for demographic and clinical variables.

Results.

Among the 729 patients included, four distinct trajectories of mental health HRQoL recovery were identified based on longitudinal MCS scores: Low-stable (persistently low MCS [12%]), Moderate-stable (intermediate and unchanged MCS [36%]), Good-stable (high and stable MCS [38%]), and Improved (low baseline MCS with postoperative improvement [14%]). Pairwise comparisons showed that the Improved group achieved significantly greater gains in disability (NDI, P <0.001), neck pain (NRS neck, P =0.002), mental health HRQoL (MCS, P <0.001), and physical health (PCS, P =0.001) compared with the Low-stable group, while changes in neurologic function and arm pain did not differ. Trajectory group membership was associated with satisfaction: compared with Low-stable, Good-stable (OR 7.39, 95% CI 3.09–17.70) and Improved (OR 4.18, 95% CI 1.77–9.87) groups were significantly more likely to report being satisfied at 12 months.

Conclusion.

Mental health HRQoL recovery following DCM surgery is heterogeneous, with only a minority of patients achieving substantial postoperative improvement. Whether routine assessment of mental-health HRQoL or targeted perioperative support alters outcomes is an area of research that warrants prospective study.

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