Relating preoperative MCS-12 to microdiscectomy outcomes

Jeremy C Heard; Yunsoo Lee; Teeto Ezeonu; Mark J Lambrechts; Rajkishen Narayanan; Caleb Yeung; Justin Wright; John Paulik; Caroline Purtill; John J Mangan; Mark F Kurd; Ian D Kaye; Jose A Canseco; Alan S Hilibrand; Alexander R Vaccaro; Gregory D Schroeder; Christopher K Kepler

doi:10.1007/s00586-023-08090-9

Relating preoperative MCS-12 to microdiscectomy outcomes

Eur Spine J. 2024 Apr 17. doi: 10.1007/s00586-023-08090-9. Online ahead of print.

Authors

Jeremy C Heard¹, Yunsoo Lee², Teeto Ezeonu¹, Mark J Lambrechts¹, Rajkishen Narayanan¹, Caleb Yeung¹, Justin Wright¹, John Paulik¹, Caroline Purtill¹, John J Mangan¹, Mark F Kurd¹, Ian D Kaye¹, Jose A Canseco¹, Alan S Hilibrand¹, Alexander R Vaccaro¹, Gregory D Schroeder¹, Christopher K Kepler¹

Affiliations

¹ Spine Surgery, Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5thFloor, Philadelphia, PA, 19107, USA.
² Spine Surgery, Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5thFloor, Philadelphia, PA, 19107, USA. yunsoo.lee@rothmanortho.com.

PMID: 38630247
DOI: 10.1007/s00586-023-08090-9

Abstract

Purpose: To determine the impact of poor mental health on patient-reported and surgical outcomes after microdiscectomy.

Methods: Patients ≥ 18 years who underwent a single-level lumbar microdiscectomy from 2014 to 2021 at a single academic institution were retrospectively identified. Patient-reported outcomes (PROMs) were collected at preoperative, three-month, and one-year postoperative time points. PROMs included the Oswestry Disability Index (ODI), Visual Analog Scale Back and Leg (VAS Back and VAS Leg, respectively), and the mental and physical component of the short form-12 survey (MCS and PCS). The minimum clinically important differences (MCID) were employed to compare scores for each PROM. Patients were categorized as having worse mental health or better mental health based on a MCS threshold of 50.

Results: Of 210 patients identified, 128 (61%) patients had a preoperative MCS score ≤ 50. There was no difference in 90-day surgical readmissions or spine reoperations within one year. At 3- and 12-month time points, both groups demonstrated improvements in all PROMs (p < 0.05). At three months postoperatively, patients with worse mental health had significantly lower PCS (42.1 vs. 46.4, p = 0.004) and higher ODI (20.5 vs. 13.3, p = 0.006) scores. Lower mental health scores were associated with lower 12-month PCS scores (43.3 vs. 48.8, p < 0.001), but greater improvements in 12-month ODI (- 28.36 vs. - 18.55, p = 0.040).

Conclusion: While worse preoperative mental health was associated with lower baseline and postoperative PROMs, patients in both groups experienced similar improvements in PROMs. Rates of surgical readmissions and reoperations were similar among patients with varying preoperative mental health status.

Keywords: Disc herniation; Lumbar spine; Mental health; Microdiscectomy; Outcomes.