To explore the impact of preoperative psychological state on postoperative clinical outcomes in patients with cervical spondylotic myelopathy treated by anterior cervical surgery.

A retrospective analysis was performed on the clinical data of 158 patients diagnosed with cervical spondylotic myelopathy who underwent anterior cervical surgery at Xuzhou Central Hospital from July 2019 to May 2022. The cohort comprised 86 males and 72 females, with ages ranging from 33 to 84 years and an average age of (57.59±11.64) years. Based on the preoperative mental state quality of life score (SF-12 MCS), the patients were divided into a psychological distress group and a non-psychological distress group. The general data such as age, gender, body mass index (BMI), and preoperative hospital stay were compared between the two groups. Additionally, clinical scores such as the Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score, visual analogue scale (VAS) score, MCS score, and patient satisfaction were evaluated both prior to the operation and at the final follow-up. Logistic regression analysis was used to identify the factors influencing the improvement of psychological state scores at the last follow-up in the psychological distress group. The postoperative satisfaction rate among patients experiencing psychological distress was 81.6%, compared to 89.9% in those without psychological distress. However, the comparison between the two groups revealed no statistically significant difference (χ²=2.09, P=0.148).

All patients were followed, with an average follow-up duration of (27.22±1.85) months. Forty-nine patients (31%) experienced psychological distress prior to surgery. The preoperative hospital stay and overall length of stay for the psychological distress group were significantly longer than those of the non-psychological distress group (P<0.001). Preoperative NDI, PCS, and MCS scores, as well as MCS scores at the last follow-up differed significantly between the two groups (P<0.05). However, there were no statistically significant differences (P>0.05) in the improvement rates of JOA, VAS, and NDI scores between the 2 groups. In patients with psychological distress, JOA, VAS, and NDI scores at the last follow-up showed statistically significant differences compared to preoperative scores (P<0.001). Twenty-five patients in the psychological distress group had a last follow-up SF-12 MCS score of ≥50, and the improvement in SF-12 MCS scores at the last follow-up compared to the group without psychological distress was statistically significant (P<0.001). Logistic regression analysis showed that age, BMI, and surgical method had no significantly significant effect on last follow-up MCS scores (P>0.05). In contrast, preoperative psychological state, MCS scores, follow-up duration, and female gender were found to be correlated with last follow-up MCS scores (r=0.78, 0.15, and -2.45; P=0.001, 0.032, and 0.048, respectively).

The incidence of psychological distress among patients with cervical spondylotic myelopathy is relatively high. Anterior surgical intervention can lead to significant improvements in both disease-related scores and quality of life scores for these patients. Female gender, low baseline preoperative MCS score, and short follow-up time are important influencing factors for poor postoperative MCS score improvement in patients with psychological distress. However, it is noteworthy that preoperative psychological distress does not impact the enhancement of neurological function or overall postoperative satisfaction.