Depression as a prognostic factor of lumbar spinal stenosis: a systematic review

Background contextThe clinical syndrome of lumbar spinal stenosis (LSS) is a commonly diagnosed lumbar condition associated with pain and disability. Psychological factors, including depression, also affect these and other health-related outcomes. Yet, the prognostic value of depression specifically in the context of LSS is unclear.PurposeThe aim of this systematic review was to examine the literature on depression as a prognostic factor of outcomes in patients with LSS.Study designBest-evidence synthesis.Patient samplePatients receiving the diagnosis of LSS and surgery.MethodsA best-evidence synthesis was conducted, including articles published between 1980 and May 2012. Each article meeting inclusion criteria, including a longitudinal design, was critically appraised on its methodological quality by two authors independently, who then met to reach consensus. Only studies deemed scientifically admissible were included in the review.ResultsAmong the 20 articles that met the inclusion criteria, 13 were judged scientifically admissible. The evidence supports an association between preoperative depression and postoperative LSS-related symptom severity (a combination of pain, numbness, weakness and balance issues) and disability. The effect size for these associations was variable, ranging from no effect to a moderate effect. For example, an increase of 5 points on a 63-point depression scale doubled the odds of being below the median in LSS-related symptom severity at follow-up. Findings on the association between preoperative depression and postoperative pain alone and walking capacity were more variable.ConclusionsFindings support that preoperative depression is likely a prognostic factor for postoperative LSS-related symptom severity and disability at various follow-up points. The prognostic value of depression on the outcomes of pain and walking capacity is less clear. Nonetheless, depression should be considered in the clinical care of this population.