The effect of preoperative mental health on outcomes of cervical spine surgery: A systematic review and meta-analysis.

BACKGROUND AND

OBJECTIVE

Mental health comorbidities have a significant impact on outcomes following cervical spine surgery. However, there is limited evidence clarifying the relationship between mental health and surgical outcomes. We sought to perform a systematic review and meta-analysis of the impact of mental health comorbidities on outcomes following cervical spine surgery.

METHODS

Medline, Embase, Scopus, and Web of Science were searched from inception to September 2024 for observational studies that investigated the association between preoperative mental health and outcomes following cervical spine surgery. Any mental health comorbidity, including but not limited to depression, anxiety, post-traumatic stress disorder (PTSD), bipolar, and others were included. The results were pooled using a restricted maximum-likelihood estimation random-effects model with inverse variance weighting. Cochrane’s Q was used to estimate heterogeneity between studies. Study quality was assessed via the Newcastle–Ottawa Scale (NOS).

RESULTS

A total of 17 studies met inclusion criteria, totaling 259,915 patients [mean age: 56, 47.6% male). Of the studies, 10/17 (58.8%) reported on depression alone, while 7/17 (41.2%) reported a combination of mental health comorbidities. The majority of the studies (10/17) were of fair quality and did not influence study inclusion. After pooling patient functional, pain, disability, and quality of life scores, patients with preoperative mental health comorbidities had less improvement following cervical spine surgery (SMD -0.3345, 95%CI -0.6419 – 0.0272, p = 0.03, I2 = 95%). Additionally, patients with preoperative mental health comorbidities were also more likely to have complications following cervical spine surgery [OR 1.39, 95%CI 1.083 – 1.79, p = 0.01, I2 = 95%]. There was significant heterogeneity.

CONCLUSIONS

Preoperative mental health comorbidities were associated with worse outcomes and increased rates of complications after cervical spine surgery. These findings highlight the influence of mental health on surgical recovery and suggest that addressing mental health preoperatively may improve patient outcomes. Future research is needed to validate these results in prospective cohorts and explore targeted interventions for preoperative optimization.