Impact of depression on the curative effect of percutaneous lumbar discectomy for lumbar disc herniation

doi:10.3321/j.issn:1673-8225.2004.35.019

Abstract：BACKGROUND: Percutaneous lumbar discectomy(PLD) has become the major surgical approach for treatment of lumbar disc herniation(LDH). Some clinical patients with LDH are found to develop depression symptoms, but whose impact on the therapeutic effect of the surgery and postoperative rehabilitation has not been well documented.OBJECTIVE: To define sthe impact of depression on the effect of PLD in patients with LDH, and explore effective postoperative rehabilitative interventions.DESIGN: A case-controlled study.SETTING: Department of Radiology and Department of Psychiatry, the Second Affiliated Hospital of Xinxiang Medical College.PARTICIPANTS: From 74 patients with LDH who had undergone PLD in the Department of Radiology, the Second Affiliated Hospital of Xinxiang Medical College from July 2001 to December 2002, 26 were identified to have depression that complicated the diagnostically defined condition of LDH. The selected patients had the score of self-rating depression scale (SDS) ＞ 50 and were free of psychosis or such a family history. Each LDH case with depression was paired with another LDH case treated by PLD during June 1997 to March 2002, and the latter case group constituted the control group.INTERVENTIONS: Each patient was investigated separately with the SDS designed by Zung that was completed independently by the patient in a quite ward both before and after PLD. The curative effect was assessed and SDS score measured after the 6-month follow-up.SDS scores and curative effect after a 6-month follow-up.RESULTS: The incidence of depression was 35% (26/74) in the LDH patients, who had an effective rate of the treatment of 46% (14/26), significantly lower than that in the control group(81% , 21/26) (x2 =4. 282, P =0. 039). The total effective rate was 85% (22/26)in the depression group, which was not significantly different from that in the control group(92%, 23/26) (x2 =0. 754, P =0. 385) . No significant difference was noted in the constituent ratio of the curative effects between the two groups(x2 =4. 339, P = 0. 114) . The total effective rate of PLD was 92% in the 74 LDH patients. The SDS score in the depression group 6 months after PLD was remarkably different from that before PLD (56.29 ± 10.27 vs 61.37 ±9.68, t =5.701, P ＜ 0.001), and the remission rate of depression was 35%.CONCLUSION: The incidence of depression is higher in LDH patients than in normal people, a condition that compromises the effectiveness of PLD. Recognition of the role of depression may help improve the curative effect of PLD in LDH patients.