Preoperative Depression and Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To evaluate whether preoperative depression is associated with differences in improvement of PROs following ACDF by comparing improvement-from-baseline outcomes between depressed and nondepressed patients. BACKGROUND OF SUMMARY DATA: Depression has been associated with worse baseline and postoperative patient-reported outcomes (PROs) following anterior cervical discectomy and fusion (ACDF). However, most studies emphasize absolute postoperative scores rather than improvement from baseline, which more directly reflects the treatment effect. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. MEDLINE, PubMed, Cochrane Library, and Google Scholar were searched for comparative studies evaluating PROs after ACDF in patients with and without preoperative depression. Outcomes included Neck Disability Index (NDI), visual analog scale (VAS) neck pain, VAS arm pain, and SF-12 Physical and Mental Component Scores (PCS, MCS). Mean improvement from preoperative baseline to 6-month and ≥1-year follow-up was analyzed separately for depressed and nondepressed cohorts. RESULTS: A total of 6 studies encompassing 930 patients met inclusion criteria. At baseline and at all postoperative time points, depressed patients demonstrated worse absolute PROs compared with nondepressed patients. However, when improvement from baseline was analyzed, depressed patients demonstrated significantly greater improvement in disability and pain outcomes. Perioperative outcomes, including operative time, blood loss, and length of stay, did not differ between groups. CONCLUSIONS: Although patients with preoperative depression experience worse absolute postoperative PROs following ACDF, they demonstrate comparable or greater improvement in disability and pain from baseline. These findings highlight the importance of distinguishing final health status from treatment effect and suggest that depression alone should not be considered a contraindication to surgical intervention but rather a factor for preoperative counseling and expectation management. LEVELS OF EVIDENCE: Level III.