{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:17:02Z","timestamp":1780071422884,"version":"3.54.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The impact of mental health comorbidities on outcomes after lumbar spine surgery in workers\u2019 compensation (WC) patients has not been robustly explored. The goal of this study was to examine the impact of mental health comorbidities on pain, disability, quality of life, and return to work after lumbar spine surgery in WC patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>A nationwide, prospective surgical outcomes registry (National Neurosurgery Quality Outcomes Database [N2QOD]) was queried for all patients who underwent 1- to 4-level lumbar decompression and\/or fusion from 2012 to 2021. Patients were stratified on the basis of compensation status into non-WC (25,507) and WC (1018) cohorts. Baseline demographic data, perioperative safety data, and patient-reported outcome measures were compared between groups. The WC cohort was further subdivided on the basis of mental health status into patients with anxiety and depression (n = 107) and those without anxiety and depression (n = 911). Propensity matching was used to generate parity between these subgroups, generating 214 patients (107 pairs) for analysis. Perioperative safety, facility utilization, 1-year patient-reported outcomes (back and leg pain, disability, and quality of life), and return to work were measured as a function of WC and mental health comorbidity status.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 26,525 patients (25,507 non-WC and 1018 WC) who underwent 1- to 4-level lumbar spine surgery were reviewed. WC patients were younger, healthier (lower American Society of Anesthesiologists class), more likely to be minorities, less educated, and more likely to smoke and had greater baseline back pain, disability, and quality of life compared to non-WC patients. The prevalence of anxiety and depression was similar between groups (11%). WC patients had worse outcomes for all measures and lower rates of return to work compared to non-WC patients. WC patients with anxiety and depression demonstrated even greater disparities in all outcomes. After propensity matching, WC patients with anxiety and depression continued to demonstrate significantly worse outcomes in comparison to WC patients without anxiety and depression.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Disparities in outcomes after lumbar spine surgery in WC patients are exacerbated in patients with anxiety and depression. WC patients with mental health comorbidities receive the least benefit from lumbar spine surgery and may represent the most vulnerable subset of patients with spine pathology. Addressing mental health comorbidities preoperatively may represent an opportunity for valuable resource allocation and surgical optimization in the WC population.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.11.spine23630","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T16:54:58Z","timestamp":1713286498000},"page":"562-569","source":"Crossref","is-referenced-by-count":4,"title":["Mental health comorbidities in workers\u2019 compensation patients and the effect on pain, disability, quality of life, and return to work after lumbar spine surgery"],"prefix":"10.3171","volume":"40","author":[{"given":"Steve H.","family":"Monk","sequence":"first","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"},{"name":"SpineFirst, Atrium Health, Charlotte, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ummey","family":"Hani","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"},{"name":"SpineFirst, Atrium Health, Charlotte, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerry","family":"Stanley","sequence":"additional","affiliation":[{"name":"Harvard MedTech, Las Vegas, Nevada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Pfortmiller","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"},{"name":"SpineFirst, Atrium Health, Charlotte, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul K.","family":"Kim","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"},{"name":"SpineFirst, Atrium Health, Charlotte, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Bohl","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"},{"name":"SpineFirst, Atrium Health, Charlotte, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Holland","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"},{"name":"SpineFirst, Atrium Health, Charlotte, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew J.","family":"McGirt","sequence":"additional","affiliation":[{"name":"Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"},{"name":"SpineFirst, Atrium Health, Charlotte, North Carolina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"Orthopedics","first-page":"e1065","article-title":"Return to work after diskogenic fusion in workers\u2019 compensation subjects","volume":"38","author":"Anderson JT","year":"2015","unstructured":"Anderson JT, Haas AR, Percy R,  Return to work after diskogenic fusion in workers\u2019 compensation subjects. 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Phys Med Rehabil Clin N Am. 2010;21(4):659\u2013677."},{"issue":"13","key":"b6","series-title":"JAMA","first-page":"1259","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults","volume":"303","author":"Deyo RA","year":"2010","unstructured":"Deyo RA, Mirza SK, Martin BI,  Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259\u20131265."},{"issue":"19","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"1812","article-title":"Clinical outcomes after posterolateral lumbar fusion in workers\u2019 compensation patients: a case-control study","volume":"35","author":"Carreon LY","year":"2010","unstructured":"Carreon LY, Glassman SD, Kantamneni NR, Mugavin MO, Djurasovic M. Clinical outcomes after posterolateral lumbar fusion in workers\u2019 compensation patients: a case-control study. Spine (Phila Pa 1976). 2010;35(19):1812\u20131817."},{"issue":"12","key":"b8","series-title":"Spine J","first-page":"2564","article-title":"Association between compensation status and outcomes in spine surgery: a meta-analysis of 31 studies","volume":"15","author":"Cheriyan T","year":"2015","unstructured":"Cheriyan T, Harris B, Cheriyan J,  Association between compensation status and outcomes in spine surgery: a meta-analysis of 31 studies. Spine J. 2015;15(12):2564\u20132573."},{"issue":"5","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"443","article-title":"Is type of compensation a predictor of outcome after lumbar fusion?","volume":"38","author":"Gum JL","year":"2013","unstructured":"Gum JL, Glassman SD, Carreon LY. Is type of compensation a predictor of outcome after lumbar fusion? 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J Occup Rehabil. 2015;25(4):742\u2013751."},{"issue":"22","key":"b24","series-title":"Spine (Phila Pa 1976)","first-page":"1775","article-title":"Chronic opioid therapy after lumbar fusion surgery for degenerative disc disease in a workers\u2019 compensation setting","volume":"40","author":"Anderson JT","year":"2015","unstructured":"Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Chronic opioid therapy after lumbar fusion surgery for degenerative disc disease in a workers\u2019 compensation setting. Spine (Phila Pa 1976). 2015;40(22):1775\u20131784."},{"key":"b25","series-title":"Clin Neurol Neurosurg","first-page":"41","article-title":"Predictors of reoperation-free survival following decompression-alone lumbar spine surgery for on-the-job injuries","volume":"135","author":"Kukreja S","year":"2015","unstructured":"Kukreja S, Kalakoti P, Ahmed O, Nanda A. Predictors of reoperation-free survival following decompression-alone lumbar spine surgery for on-the-job injuries. 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Spine J. 2014;14(2):263\u2013273."},{"issue":"2","key":"b30","series-title":"Pain Ther","first-page":"1731","article-title":"Combining virtual reality and behavioral health to promote pain resiliency: analysis of a novel biopsychosocial modality for solving pain in the workplace","volume":"10","author":"Abd-Elsayed A","year":"2021","unstructured":"Abd-Elsayed A, Hussain N, Stanley G. Combining virtual reality and behavioral health to promote pain resiliency: analysis of a novel biopsychosocial modality for solving pain in the workplace. 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