6th September 2016
According to new research from the Hospital for Special Surgery in New York City, USA, 36.5% of patients undergoing surgical treatment for adult spinal deformity in the US Nationwide Inpatient Sample (NIS) has been coded with at least one psychological disorder catalogued in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders: 5th Edition (DSM-V). Adult spinal deformity patients displayed the highest prevalence of psychological impairment, when compared with three other disabling chronic diseases.
The research—which was presented at the International Meeting for Advanced Spine Techniques (IMAST; 13-16 July, Washington, DC, USA) by Bassel Diebo (Brooklyn, USA)—aimed to “investigate incidences of psychological disorders in adult spinal deformity patients undergoing surgical treatment.” The condition is a growing problem in the USA, according to the researchers, who attribute its increasing prevalence to the country’s ageing population. The disability associated with adult spinal deformity has been noted as “concerning” in the literature, “when compared to other self-reported chronic conditions.” Diebo explained that the psychological burden of the condition—a major factor in disability—“remains unclear” in comparison to many disabling diseases.
Diebo et al performed a retrospective review of NIS data from 2002 to 2012, using International Classification of Diseases, Ninth Revision coding to identify patients with adult spinal deformity undergoing more than four levels of fusion (n=17,536). The research team also searched for patients with cardiac diseases (n=2,675,767), type one and/or two diabetes (n=1,137,435), and lung cancer (n=363, 334). The total population included from the NIS database during this period was 4,194,073.
Using the DSM-5 manual, Diebo and colleagues identified incidences of depressive, anxiety, obsessive-compulsive, stress, somatic symptom, sexual dysfunction, substance abuse, delirium and personality disorders in patients within each chronic disease group.
Results showed that adult spinal deformity patients had “the highest prevalence of any psychological disorder” amongst the groups (p<0.001). Thirty-six point five per cent of these patients experienced at least one psychological disorder, followed by cardiac disease patients (33.3%), diabetic patients (28.3%) and lung cancer patients (24%).
When stratified according to age, researchers found that, amongst adult spinal deformity patients with psychological disorders, “61.7% were between 55 and 74 years old”. Six point two per cent were between 25 and 40 years old, with 12.2% over seventy-five years of age.
Amongst the patients, the most common disorders for 55-74 year olds were depressive, anxiety and sleep disorders. Amongst the younger age bracket of 41-54 years, however, the most common psychological disorders were substance abuse-based. Of the four most common psychological disorders amongst the population—depressive, sleep, anxiety and substance abuse—adult spinal deformity patients exhibited the highest percentage of the former three.
In conclusion, Diebo highlighted the prevalence of psychological disorders amongst this group, emphasising that “one in every three adult spinal deformity patients” was coded with at least one psychological disorder. Diebo recommended that “proper psychological screening, patient counselling and appropriate support” should be a part of adult spinal deformity treatment.