A systematic review on the prevalence of preoperative and postoperative depression in lumbar fusion



      Depression and Degenerative Spine Disease (DSD) frequently co-exist. Pooled prevalence estimates of depression before and after lumbar fusion surgery has not been analyzed before. The purpose of this systematic review was to estimate the pre- and post-operative prevalence of depression in patients with DSD undergoing lumbar fusion.


      A literature review until April 30th 2022 was performed. All studies on DSD patients undergoing lumbar spine fusion surgery with either a history of formal diagnosis of depression or a recording of depression using a validated tool were included. Patients with other psychiatric conditions or undergoing a different form of spinal surgery were excluded. Risk of bias of the included studies was evaluated using the Newcastle-Ottawa Scale.


      Fifteen (15) studies with a total of 98.375 patients met the inclusion and exclusion criteria and were included in the analysis. The prevalence estimate of depression in patients before surgery was 15,35 % (95% CI: 10,56–20,86%). In the 7 studies including patients who had undergone lumbar fusion, the pooled prevalence was estimated 11,46% (95% CI: 8,11–15,30%).


      An increased prevalence of depression in patients undergoing lumbar spine fusion was noted. Given the correlation between depression and poor surgical outcomes, strategies should be identified to prevent and treat depression in these patients.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Martin, B.I., Mirza, S.K., Spina, N., Spiker, W.R., Lawrence, B., Brodke, D.S., 2019. Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 44, 369–376. 10.1097/brs.0000000000002822.

        • Hilibrand A.S.
        • Rand N.
        Degenerative lumbar stenosis: diagnosis and management.
        J Am Acad Orthop Surg. 1999; 7: 239-249
        • Pollock R.
        • Lakkol S.
        • Budithi C.
        • Bhatia C.
        • Krishna M.
        Effect of psychological status on outcome of posterior lumbar interbody fusion surgery.
        Asian Spine J. 2012; 6: 178-182
        • Munce S.E.P.
        • Stansfeld S.A.
        • Blackmore E.R.
        • Stewart D.E.
        The role of depression and chronic pain conditions in absenteeism: results from a national epidemiologic survey.
        J Occup Environ Med. 2007; 49: 1206-1211
        • Hoffman R.M.
        • Wheeler K.J.
        • Deyo R.A.
        Surgery for herniated lumbar discs: a literature synthesis.
        J Gen Intern Med. 1993; 8: 487-496
      2. Turner, J.A., Ersek, M., Herron, L., Deyo, R., 1992. Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine (Phila Pa 1976) 17, 1–8. 10.1097/00007632-199201000-00001.

        • Wertli M.M.
        • Buletti F.C.
        • Held U.
        • Rasmussen-Barr E.
        • Weiser S.
        • Burgstaller J.M.
        • et al.
        A comparison between different outcome measures based on “meaningful important differences” in patients with lumbar spinal stenosis.
        Eur Spine J. 2017; 26: 450-461
        • Järvimäki V.
        • Kautiainen H.
        • Haanpää M.
        • Koponen H.
        • Spalding M.
        • Alahuhta S.
        • et al.
        Depressive symptoms are associated with poor outcome for lumbar spine surgery.
        Scand J Pain. 2016; 12: 13-17
        • DeBerard M.S.
        • Colledge A.L.
        • Masters K.S.
        • Schleusener R.L.
        • Schlegel J.D.
        Outcomes of posterolateral versus BAK titanium cage interbody lumbar fusion in injured workers: a retrospective cohort study.
        J South Orthop Assoc. 2002; 11: 157-166
        • Koyanagi A.
        • Köhler-Forsberg O.
        • Benros M.E.
        • Munk Laursen T.
        • Haro J.M.
        • Nordentoft M.
        • et al.
        Mortality in unipolar depression preceding and following chronic somatic diseases.
        Acta Psychiatr Scand. 2018; 138: 500-508
      3. Wells G, Shea B, O’connell D et al The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses.Ottawa Hospital Research Institute. oxford. asp, 2011.

        • Wahlman M.
        • Häkkinen A.
        • Dekker J.
        • Marttinen I.
        • Vihtonen K.
        • Neva M.H.
        The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion.
        Eur Spine J. 2014; 23: 129-134
      4. Levin, J.M., Winkelman, R.D., Smith, G.A., Tanenbaum, J.E., Benzel, E.C., Mroz, T.E., Steinmetz, M.P., 2017. Impact of Preoperative Depression on Hospital Consumer Assessment of Healthcare Providers and Systems Survey Results in a Lumbar Fusion Population. Spine (Phila Pa 1976) 42, 675–681.

      5. Anderson, J.T., Haas, A.R., Percy, R., Woods, S.T., Ahn, U.M., Ahn, N.U., 2015. Clinical depression is a strong predictor of poor lumbar fusion outcomes among workers’ compensation subjects. Spine (Phila Pa 1976) 40, 748–756. 10.1097/BRS.0000000000000863.

        • Toivonen L.
        • Häkkinen A.
        • Pekkanen L.
        • Salonen A.
        • Kautiainen H.
        • Neva M.H.
        Influence of Depressive Symptoms on the Outcome of Lumbar Spine Fusion—A 5-year Follow-up Study.
        Spine. 2021; 46: 408-412
        • Walid M.S.
        • Zaytseva N.V.
        Prevalence of mood-altering and opioid medication use among spine surgery candidates and relationship with hospital cost.
        Journal of Clinical Neuroscience. 2010; 17: 597-600
        • Goyal D.K.C.
        • Stull J.D.
        • Divi S.N.
        • Galtta M.S.
        • Bowles D.R.
        • Nicholson K.J.
        • et al.
        Combined Depression and Anxiety Influence Patient-Reported Outcomes after Lumbar Fusion.
        International Journal of Spine Surgery. 2021; (10.14444/8008)
        • O’Connell C.
        • Azad T.D.
        • Mittal V.
        • Vail D.
        • Johnson E.
        • Desai A.
        • et al.
        Preoperative depression, lumbar fusion, and opioid use: an assessment of postoperative prescription, quality, and economic outcomes.
        Neurosurg Focus. 2018; 44: E5
      6. Zhou, Y., Deng, J., Yang, M., Chang, Y., Zhang, Y., Xu, G., Wang, B., Li, Z., 2021. Does the Preoperative Depression Affect Clinical Outcomes in Adults With Following Lumbar Fusion?: A Retrospective Cohort Study. Clin Spine Surg 34, E194–E199. 10.1097/BSD.0000000000001102.

        • Kashlan O.
        • Swong K.
        • Alvi M.A.
        • Bisson E.F.
        • Mummaneni P.V.
        • Knightly J.
        • et al.
        Patients with a depressive and/or anxiety disorder can achieve optimum Long term outcomes after surgery for grade 1 spondylolisthesis: Analysis from the quality outcomes database (QOD).
        Clin Neurol Neurosurg. 2020; 197106098
      7. Stull, J.D., Divi, S.N., Goyal, D.K.C., Bowles, D.R., Reyes, A.A., Bechay, J., Sonnier, J.H., Nachwalter, R.N., Zarowin, J.J., Galetta, M.S., Kaye, I.D., Woods, B.I., Kurd, M.F., Radcliff, K.E., Rihn, J.A., Anderson, D.G., Hilibrand, A.S., Kepler, C.K., Vaccaro, A.R., Schroeder, G.D., 2020. Preoperative Mental Health Component Scoring Is Related to Patient Reported Outcomes Following Lumbar Fusion. Spine (Phila Pa 1976) 45, 798–803. 10.1097/BRS.0000000000003399.

        • Goh G.-S.-H.
        • Liow M.H.L.
        • Yeo W.
        • Ling Z.M.
        • Yue W.-M.
        • Guo C.-M.
        • et al.
        Patients With Poor Baseline Mental Health May Experience Significant Improvements in Pain and Disability After Minimally Invasive Transforaminal Lumbar Interbody Fusion: A 5-Year Follow-up Study.
        Clin Spine Surg. 2020; 33: 205-214
      8. Bekeris, J., Wilson, L.A., Fiasconaro, M., Poeran, J., Liu, J., Girardi, F., Memtsoudis, S.G., 2020. New Onset Depression and Anxiety After Spinal Fusion Surgery: Incidence and Risk Factors. Spine (Phila Pa 1976) 45, 1161–1169. 10.1097/BRS.0000000000003467.

      9. Connolly, J., Javed, Z., Raji, M.A., Chan, W., Kuo, Y.-F., Baillargeon, J., 2017. Predictors of Long Term Opioid Use following Lumbar Fusion Surgery. Spine (Phila Pa 1976) 42, 1405–1411.

        • Huang Y.-C.
        • Chang C.-H.
        • Lin C.-L.
        • Wang L.-J.
        • Hsu C.-W.
        • Su Y.-F.
        • et al.
        Prevalence and Outcomes of Major Psychiatric Disorders Preceding Index Surgery for Degenerative Thoracic/Lumbar Spine Disease.
        Int J Environ Res Public Health. 2021; 18: 5391
        • Held U.
        • Burgstaller J.M.
        • Deforth M.
        • Steurer J.
        • Pichierri G.
        • Wertli M.M.
        Association between depression and anxiety on symptom and function after surgery for lumbar spinal stenosis.
        Sci Rep. 2022; 12: 2821
      10. Torre, J.A. la, Vilagut, G., Ronaldson, A., Serrano-Blanco, A., Martín, V., Peters, M., Valderas, J.M., Dregan, A., Alonso, J., 2021. Prevalence and variability of current depressive disorder in 27 European countries: a population-based study. The Lancet Public Health 6, e729–e738. 10.1016/S2468-2667(21)00047-5.

        • Wilson B.R.
        • Tringale K.R.
        • Hirshman B.R.
        • Zhou T.
        • Umlauf A.
        • Taylor W.R.
        • et al.
        Depression After Spinal Surgery: A Comparative Analysis of the California Outcomes Database.
        Mayo Clin Proc. 2017; 92: 88-97
      11. Diebo, B.G., Lavian, J.D., Murray, D.P., Liu, S., Shah, N.V., Beyer, G.A., Segreto, F.A., Bloom, L., Vasquez-Montes, D., Day, L.M., Hollern, D.A., Horn, S.R., Naziri, Q., Cukor, D., Passias, P.G., Paulino, C.B., 2018. The Impact of Comorbid Mental Health Disorders on Complications Following Adult Spinal Deformity Surgery With Minimum 2-Year Surveillance. Spine (Phila Pa 1976) 43, 1176–1183. 10.1097/BRS.0000000000002583.

        • Schoell K.
        • Wang C.
        • D’Oro A.
        • Heindel P.
        • Lee L.
        • Wang J.C.
        • et al.
        Depression Increases the Rates of Neurological Complications and Failed Back Surgery Syndrome in Patients Undergoing Lumbar Spine Surgery.
        Clin Spine Surg. 2019; 32: E78-E85
        • Mayo B.C.
        • Narain A.S.
        • Hijji F.Y.
        • Massel D.H.
        • Bohl D.D.
        • Singh K.
        Preoperative Mental Health May Not Be Predictive of Improvements in Patient-Reported Outcomes Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion.
        International Journal of Spine Surgery. 2020; 14: 26-31
        • Skolasky R.L.
        • Riley L.H.
        • Maggard A.M.
        • Wegener S.T.
        The relationship between pain and depressive symptoms after lumbar spine surgery.
        Pain. 2012; 153: 2092-2096
        • Parrish J.M.
        • Jenkins N.W.
        • Massel D.H.
        • Rush A.J.
        • Parrish M.S.
        • Hrynewycz N.M.
        • et al.
        The Perioperative Symptom Severity of Higher Patient Health Questionnaire-9 Scores Between Genders in Single-Level Lumbar Fusion.
        Int J Spine Surg. 2021; 15: 62-73
        • Triebel J.
        • Snellman G.
        • Sandén B.
        • Strömqvist F.
        • Robinson Y.
        Women do not fare worse than men after lumbar fusion surgery: Two-year follow-up results from 4,780 prospectively collected patients in the Swedish National Spine Register with lumbar degenerative disc disease and chronic low back pain.
        Spine J. 2017; 17: 656-662
        • Chen Z.
        • Luo R.
        • Yang Y.
        • Xiang Z.
        The prevalence of depression in degenerative spine disease patients: A systematic review and meta-analysis.
        Eur Spine J. 2021; 30: 3417-3427