The Impact of the Depression and Anxiety on Prognosis of Cervical Total Disc Replacement

Study Design. Prospective clinical study. Objective. To identify changes in depression and anxiety after cervical total disc replacement (CTDR) among patients with cervical spondylosis, and to investigate their effects on the prognosis. Summary of Background Data. Previous researches have reported relationships between mood disorders and lumbar surgery. There have been no previous studies on the effects of depressive and anxiety on the CTDR outcome at the 2-year postoperative phase. Methods. Eighty-five patients with cervical spondylosis who underwent CTDR were included. Patients were evaluated preoperatively and at 6 postoperative time points, including 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years. Depression and anxiety were evaluated by using the Zung Self-Rating Depression Scale and the Zung Self-Rating Anxiety Scale. Neurological function was evaluated by using the visual analogue scale and the Japanese Orthopaedic Association. The quality of life was assessed by a 36-item Short-Form Health Survey. A Spearman rank correlation analysis was used. Results. All patients had improvements in clinical symptoms and neurological function. Twelve (14.12%) patients had symptoms of depression and 21 (24.71%) patients had symptoms of anxiety. There was a significant difference between the preoperative and the postoperative Zung Self-Rating Anxiety Scale scores, whereas the Zung Self-Rating Depression Scale scores were not significantly different over time. For all patients, the visual analogue scale scores and the 36-item Short-Form Health Survey scores were associated with the postoperative level of depression and anxiety but not age or the Japanese Orthopaedic Association score. Conclusion. Some patients with cervical spondylosis have preoperative depression and/or anxiety. CTDR may provide some improvements in these psychological symptoms. The presence of depression and/or anxiety may have a negative influence on the patient's prognosis.