Depression among lumbar spine surgery patients: Uncovering the untold story

Background: Depression is highly prevalent among patients with lumbar degenerative disease and is associated with worse postoperative outcomes. However, a significant proportion of affected individuals remain undiagnosed. We aimed to evaluate the utility of PROMIS Depression scores in identifying patients with undiagnosed depression undergoing lumbar spine surgery and to characterize their clinical outcomes relative to patients with diagnosed and no depression. Methods: This retrospective cohort study included patients undergoing 1- or 2-level lumbar decompression or fusion between March 2019 and November 2021. Patients were stratified into three cohorts: diagnosed depression (PDD), no depression (NDD), and at-risk for undiagnosed depression (ARUD), defined as PROMIS Depression ≥55 without an ICD-10 diagnosis. Patient-reported outcomes were assessed preoperatively and at 6, 12, and 24 months postoperatively. Between group comparisons and baseline-adjusted ANCOVA models were performed, including subgroup analyses by procedure type (fusion vs. decompression) and revision status. Results: Of 286 ICD-10-negative patients, 24.1% (n=69) met criteria for ARUD. Patient-reported outcome scores across all domains in the ARUD cohort mirrored those of the PDD group and were significantly worse than those of the NDD cohort at all timepoints (p0.77) and moderate correlations with other domains. No significant difference was observed in outcomes between treated and untreated PDD patients. Older age was associated with reduced likelihood of diagnosis, while substance abuse history, pain clinic enrollment, and retired status predicted higher risk of undiagnosed depression. Conclusions: PROMIS Depression scores can identify patients with undiagnosed depression who experience similar impairments and postoperative outcomes as those with diagnosed depression. These findings support the routine use of PROMIS Depression as a screening tool to enhance preoperative psychiatric assessment in spine surgery patients.