Effect of Depressive Symptoms on Return to Work after Lumbar Spine Fusion Surgery: A Retrospective Registry Study

Study Design. Retrospective registry study. Objective. To investigate the influence of depressive symptoms on return to work (RTW) after lumbar spine fusion (LSF) surgery over a 2-year follow-up. A secondary objective was to evaluate the development of depressive symptoms separately in patients who succeeded or failed to RTW after surgery. Summary of Background Data. Depressive symptoms are overrepresented in patients undergoing LSF surgery. The effect of depressive symptoms on RTW after LSF surgery has not yet been widely studied. Methods. A total of 348 consecutive patients available to the workforce underwent LSF surgery. Depressive symptoms were evaluated at baseline and 3, 12 and 24 months postoperatively using the MHI-5. Lower scores have been shown to indicate greater depressive symptoms, and a cut-off score of 68 or less indicates current major depressive disorder (MDD). Cumulative RTW and MHI-5 scores were prospectively followed up at the aforementioned time points. Results. Before surgery, almost half (46%) of the patients had MDD. The presence of preoperative MDD indicated a lower RTW at 2 years (72% vs. 82%, adjusted HR 0.77 [95% CI: 0.61-0.98]). The probability of RTW was correlated with an increase in the MHI-5 score until the inflection point of 70, after which a further increase in the MHI-5 score no longer increased the probability of RTW. In addition, the MHI-5 score was significantly higher than baseline at 3 months postoperatively (13 points [95% CI: 10-15]) and remained higher in patients who RTW during 2 years. However, only a marginal increase in MHI-5 was observed in those who failed to RTW. This finding indicates fewer depressive symptoms in patients who successfully RTW. Conclusion. Patients with preoperative MDD were less likely to RTW after LSF surgery. After surgery, depressive symptoms diminished in the group who did successfully RTW. Level of Evidence. 3.