Impact of psychological status on lumbocrural pain treatment undergoing transforaminal percutaneous endoscopic lumbar discectomy

Purpose:
Although transforaminal percutaneous endoscopic lumbar discectomy (T-PELD) has been widely accepted by spinal surgeons and pain specialists to treat lumbar disc herniation, few studies have focused on the impact of preoperative psychological distress on intraoperative patient manifestations of this wide-awake procedure under local anesthesia. We aimed to investigate the impact of preoperative psychological status on the intraoperative cooperation, vasovagal reactions (VVR) and short-term outcomes in lumbar disc herniation (LDH) patients undergoing transforaminal percutaneous endoscopic lumbar discectomy (T-PELD), as well as to seek risk factors for vital psychological distress.

Methods:
From December 2014 and December 2019, 182 symptomatic LDH patients (98 males and 84 females) were successfully performed T-PELD surgery, and separately classified into non-Anxiety group(nA) and Anxiety group(A) or non-Depression group(nD) and Depression group(D), depending on the Hospital Anxiety and Depression Scale (HADS) subscales scores. The preoperative sociodemographic data, intraoperative cooperation, VVR state and postoperative short-term outcomes were analyzed.

Results:
Among 182 surgical patients, 39 patients showed depression status with 56 patients in anxiety status. The disease duration of patients for nA and A groups (18.77±22.143 vs. 30.50±18.299, P＜0.001) and the age of patients for nD and D groups(42.00±13.236 vs. 59.31±4.736, P＜0.001) were significant difference. According to the grades we set, the distribution of four intraoperation cooperation degree(0/1/2/3) of patients in nA and A groups was 15/90/20/1 vs. 2/18/28/8 (P＜0.001), but that of patients in nD and D groups was 15/86/34/8 vs. 2/22/14/1 (P=0.349).There were 24 patients obtaining VVR symptoms during T-PELD. The Anxitey subscale scores were higher in VVR group than non-VVR group(8.46±1.744 vs. 6.94±1.617, P＜0.001) and there was no significant difference between two groups according to Depression subscale scores(6.33±1.274 vs. 6.75±1.509, P=0.197). The VAS and JOA scores were both improved in all patients at 12 months after surgery (P＜0.001). The VAS scores of patients were lower(2.83±0.713 vs. 4.18±0.811, P＜0.001) and the JOA scores of patients were lower(19.60±1.415 vs. 17.48±1.112, P＜0.001) in nA group than A group at 12 months postoperation. However, the VAS scores of patients were lower(3.13±0.941 vs. 3.69±0.950, P=0.003) and the JOA scores of patients were lower(19.04±1.587 vs. 18.59±1.831, P=0.129) in nD group than D group at 12 months postoperation.

Conclusion:
The anxiety is more common than depression in LDH patient and the patients with anxiety status have worse intraoperative cooperation, more VVR experience and worse short-term outcomes than those without during T-PELD. In addition, the long duration of disease was the main risk factor for anxiety status.