Validity Of Patient Health Questionnaire-9 In Minimally Invasive Lumbar Interbody Fusion

Nathaniel W. Jenkins, MS1; James M. Parrish, MPH1; Nadia Hrynewycz, BS1; Thomas Brundage, BS1; Joon Yoo, BA1; Kern Singh1,2

1Department of Orthopaedic Surgery, Rush University Medical Center2Professor, Co-Director of the Minimally Invasive Spine Institute at Rush University Medical Center;

Founder and President, Minimally Invasive Spine Study Group

DisclosuresNathaniel W. Jenkins, MS; James M. Parrish, MPH; Nadia Hrynewycz, BS; Thomas Brundage, BS; Joon Yoo, BA Nothing to disclose

Kern Singh, MD

• Royalties – Zimmer Biomet, Stryker K2M, RTI Surgical, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, Slack Publishing

• Stock Ownership - TDi, LLC and Vital 5, LLC.• Consulting - Zimmer Biomet, Stryker K2M• Board Membership – Vital 5 LLC, TDi LLC, Minimally Invasive Spine Study Group• Editorial Board - Contemporary Spine Surgery, Orthopedics Today, Vertebral Columns• Board of Directors / Committee Membership - CSRS, ISASS, AAOS• Grants - Cervical Spine Research Society

Introduction

• Preoperative depression & anxiety predict postop pain and physical impairments

• Better identify and accommodate patients before surgery

Aims and Objectives

This study aims to … Examine relationship of depression in patients undergoing MIS lumbar fusions, as measured by:

• PHQ-9 • SF-12 Mental Component Summary

scores (MCS) • VR-12 MCS

Methodology

● Prospectively-maintained registry, retrospective review

● 215 patients that underwent aprimary, 1 or 2 level MIS TLIF for degenerative spondylolisthesis were identified

Methodology

• Variables Analyzed• Patient demographics• Perioperative and

operative variables• Patient-Reported

Outcomes (PROs)■ PHQ-9,■ SF-12 MCS■ VR-12 MCS

• Statistical Analyses• Student’s t-test• Chi-Squared analysis• Pearson correlation coefficient• Strengths of correlation were

Results

Patients demonstrated significant improvement in ODI and VAS Back and Leg pain at 6-months follow-up

Statistically significant improvements in:

● PHQ-9● SF-12 MCS● VR-12 MCS

Results

Strong Correlations for all, |r|≥ 0.5 p < 0.05

ResultsVR-12 vs PHQ-9 Correlations

Preop 6 weeks 12 weeks

6 months 12 months

ResultsSF-12 vs PHQ-9 Correlations

Preop 6 weeks 12 weeks

6 months 12 months

Discussion

● Mental health significantly improves as measured by:

○ PHQ-9○ SF-12 MCS○ VR-12 MCS

● PHQ-9 strongly correlates with:○ SF-12○ VR-12

Limitations

• Due to loss to follow up, sample size differed for various patient-reported outcome measures

• Limited sample size (n=215)

• Retrospective nature of the study can impart selection bias

Conclusions

• PHQ-9 can be used as valid screening even in absence of SF-12 & VR-12

• May effectively screen patients in less time

• Limiting number of questionnaires could reduce survey burden

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