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Purpose: As more patients undergo lumbar spine surgery, novel interventions may improve physical and mental health outcomes. Few studies summarize the benefit of cognitive behavioral therapy (CBT) among lumbar spine surgery patients. This study collects randomized control trial data to investigate the influence of CBT on patient reported outcomes among lumbar spine surgery patients. Methods: Our study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and a medical library expert assisted in searching PubMed/MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, and Google Scholar. We calculated standardized mean differences (SMD) to evaluate the effect size of CBT versus control groups with a sensitivity analysis. Results: Our meta-analysis included seven studies with a total of 531 patients. The majority of included studies evaluated lumbar fusion, with preoperative CBT performed by physiotherapists. The largest effects were observed for overall quality of life (SMD = 0.55 [95% CI 0.05, 1.05], p < 0.001, I2 = 86.7%) and psychological outcomes (SMD = 0.61 [95% CI 0.28, 0.94], p < 0.001, I2 = 89.7%) though disability and pain outcomes also favored CBT intervention. Included studies demonstrated low overall bias but large heterogeneity. Sensitivity analysis demonstrated negligible study design differences and revealed moderators including CBT session frequency and final follow-up duration (p < 0.001). Conclusion: Compared to usual care or alternative therapy control arms, CBT delivered the most improvement with overall quality of life and psychological outcomes. Among appropriately selected patients, CBT could improve perioperative disability, pain, quality of life, and psychological health following lumbar spine surgery. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective.Objective: The aim of this study was to evaluate the validity of Patient Health Questionnaire-9 (PHQ-9) among patients undergoing minimally invasive (MIS) lumbar interbody fusion.Summary Of Background Data: Few studies have evaluated the utility and concurrent validity of the PHQ-9 survey in patients undergoing spinal procedures.Methods: Patients undergoing a one- or two-level MIS lumbar interbody fusion were retrospectively reviewed. Patient-reported outcome surveys were completed preoperatively and at 6-week, 12-week, 6-month, and 1-year timepoints. Postoperative survey scores were compared to preoperative values using paired t tests. PHQ-9 scores were compared with the Mental Component Summary (MCS) scores of the Short Form-12 (SF-12) and the Veterans RAND-12 (VR-12) surveys at each timepoint using the Pearson correlation coefficient.Results: A total of 215 patients were included in the analysis. The mean preoperative scores for the PHQ-9, SF-12 MCS, and VR-12 MCS were 6.78, 49.55, and 50.39, respectively. Significant improvements in each survey outcome measure were observed at all postoperative timepoints. Strong correlations with PHQ-9 scores were identified for SF-12 MCS scores and VR-12 MCS scores at preoperative and postoperative timepoints (|r| ≥ 0.5 and P < 0.05 for each).Conclusion: This study demonstrated that mental health, as measured by the PHQ-9, SF-12 MCS, and VR-12 MCS surveys, improves significantly after MIS lumbar fusion. In addition, PHQ-9 scores were strongly correlated with SF-12 and VR-12 scores. These results suggest that PHQ-9 can be a valid assessment of baseline mental health and postoperative improvement after MIS lumbar fusion. Concordant results among PHQ-9, SF-12 MCS, and VR-12 indicate that the simultaneous utilization of multiple survey instruments may not be necessary. Limiting the number of questionnaires that are administered in the evaluation of mental health could also help reduce survey burden placed on patients.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate specific demographic and perioperative variables associated with higher inpatient pain scores following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).Methods: Patients who underwent a single-level, primary MIS TLIF were retrospectively reviewed. Perioperative outcomes were collected, and postoperative inpatient VAS pain scores were measured. Both bivariate and stepwise multivariate Poisson regressions with robust error variance were used to assess risk factors for average inpatient pain score ≥ 5.0. A final backward stepwise regression model was created using age, gender, smoking status, diabetes status, insurance status, BMI, comorbidity burden, pedicle screw laterality, operative time, and estimated blood loss.Results: A total of 255 patients undergoing primary, single-level MIS TLIF were included. Age less than 50 years, workers' compensation insurance, preoperative VAS pain score ≥ 7, and operative duration ≥ 110 min were associated with greater postoperative pain. However, other variables such as gender, BMI, smoking status, comorbidity burden, diabetes status, and pedicle screw laterality were not associated with increased postoperative pain.Conclusion: The results of this study suggest that younger age, workers' compensation, elevated preoperative pain scores, and longer operative times are independently associated with greater inpatient pain following TLIF. Surgeons can use this information to better assess which patients may require additional pain control following TLIF. Patient expectations of postoperative outcomes in regard to pain and recovery may also be better managed. These slides can be retrieved under Electronic Supplementary Material. (paragraph). Then process the ppt slide as graphical image. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort.Objective: To investigate and establish minimum clinically important differences (MCID) for Patient Health Questionnaire-9 (PHQ-9) among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).Summary Of Background: Spine surgery is linked to postoperative improvements in anxiety, depression, and mental health. These improvements have been documented using patient-reported outcome measures such as PHQ-9. Few studies evaluated the clinical significance of PHQ-9 for lumbar spine surgery.Methods: Patients who underwent single-level, primary MIS TLIF from 2015 to 2017 were retrospectively reviewed in a prospective database. Patients with incomplete preoperative and 2-year postoperative PHQ-9 surveys were excluded. Demographic and perioperative characteristics were recorded. PHQ-9, 12-Item Short Form (SF-12), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year intervals. MCID was calculated using anchor and distribution-based methods. SF-12 served as an anchor. MCID was assessed using mean change methodology, four receiver operating characteristic curve assessments, and standard error measurement. Cutoff values were selected from receiver operating characteristic curve analysis. MCID achievement rates for all patient-reported outcome measures were calculated.Results: A total of 139 patients met inclusion criteria, with a mean age of 55 years and 39% females. The most common spinal pathology was radiculopathy (92%). MCID analysis revealed the following ranges of values: 2.0 to 4.8 (PHQ-9), 6.7 to 12.1 (SF-12 MCS), and 7.5 to 15.9 (VR-12 MCS). Final MCID thresholds were 3.0 (PHQ-9), 9.1 (SF-12 MCS), and 8.1 (VR-12 MCS). MCID achievement at 2-years for PHQ-9, SF-12 MCS, and VR-12 MCS was 89.2%, 85.6%, and 84.9% respectively.Conclusion: Our 2-year postoperative MCID analysis is the first mental health calculation from an MIS TLIF cohort. We report a 2-year MCID value for PHQ-9 of 3.0 (2.0-4.8). MCID values for mental health instruments are important for determining overall success of lumbar spine surgery.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]