{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:01:07Z","timestamp":1781157667129,"version":"3.54.1"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Depression is common among elective lumbar spine surgery candidates and is associated with worse postoperative outcomes. Home-based transcranial direct current stimulation (tDCS) has demonstrated safety and feasibility, with evidence of antidepressant effects in remote randomized and open-label studies of major depressive disorder (MDD). Whether this approach can be feasibly and acceptably implemented as a preoperative intervention in lumbar spine surgical populations is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We propose a prospective, open-label, single-arm feasibility study evaluating preoperative, home-based tDCS for elective, non-revision lumbar spine surgery candidates with MDD. Adults aged 22\u201375\u202fyears with DSM-5 MDD and at least moderate depressive symptom severity [self-reported Montgomery\u2013\u00c5sberg Depression Rating Scale (MADRS-S)\u202f\u2265\u202f20] being evaluated for elective lumbar spine surgery will receive home-based tDCS. Key exclusion criteria include history of seizure disorder, implanted cranial electronic or metallic devices, clinically unstable psychiatric conditions, prior brain stimulation therapy, and use of medications that significantly affect cortical excitability. Pre-surgical treatment follows a standardized cadence (5 sessions\/week for 3\u202fweeks, then 3 sessions\/week) for a minimum of 4\u202fweeks, continuing until surgery or up to 10\u202fweeks. Feasibility will be assessed using a pre-specified tiered exposure framework based on the number of sessions completed before surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Anticipated results<\/jats:title>\n                    <jats:p>Primary outcomes are feasibility and acceptability of preoperative home-based tDCS delivery. The principal exploratory clinical outcome is change in depressive symptom severity measured using MADRS-S. Exploratory perioperative recovery outcomes include spine-related disability, pain intensity, functional status, and opioid utilization. For participants who proceed to surgery, postoperative outcomes will be followed up to 12\u202fmonths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This pilot study will generate feasibility, acceptability, and preliminary signal data to inform the design of future randomized controlled trials of preoperative neuromodulation in surgical populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnhum.2026.1860063","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:46:36Z","timestamp":1781156796000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A prospective, open-label feasibility study protocol of home-based transcranial direct current stimulation for major depressive disorder in elective lumbar spine surgery candidates"],"prefix":"10.3389","volume":"20","author":[{"given":"Arjun K.","family":"Menta","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel P.","family":"Bronckers","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando S.","family":"Goes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy F.","family":"Witham","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang H.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Lee H.","family":"Riley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled M.","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lubelski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Theodore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Arizona-Phoenix","place":["Phoenix, AZ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tej D.","family":"Azad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine","place":["Baltimore, MD, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"100902","DOI":"10.1016\/J.JADR.2025.100902","article-title":"Home-use transcranial direct current stimulation (tDCS) as a safe, effective, and feasible application in depression: a randomized, single-blind, placebo-controlled trial","volume":"20","author":"Akt\u00fcrk","year":"2025","journal-title":"J. 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Neuropsychopharmacol."},{"key":"ref5","year":"2026"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"765370","DOI":"10.3389\/FNAGI.2021.765370","article-title":"Safety and feasibility of tele-supervised home-based transcranial direct current stimulation for major depressive disorder","volume":"13","author":"Cappon","year":"2022","journal-title":"Front. Aging Neurosci."},{"key":"ref7","year":"2026"},{"key":"ref8","year":"2026"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"E2348565","DOI":"10.1001\/JAMANETWORKOPEN.2023.48565","article-title":"Implications of preoperative depression for lumbar spine surgery outcomes: a systematic review and meta-analysis","volume":"7","author":"Javeed","year":"2024","journal-title":"JAMA Netw. 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Neurosci."},{"key":"ref14","year":"2026"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1427365","DOI":"10.3389\/FPSYT.2024.1427365","article-title":"Multichannel tDCS with advanced targeting for major depressive disorder: a tele-supervised at-home pilot study","volume":"15","author":"Ruffini","year":"2024","journal-title":"Front. Psych."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/J.JPSYCHIRES.2022.07.026","article-title":"Adjunctive home-based transcranial direct current stimulation treatment for major depression with real-time remote supervision: an open-label, single-arm feasibility study with long term outcomes","volume":"153","author":"Woodham","year":"2022","journal-title":"J. Psychiatr. 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Med."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"3644","DOI":"10.1227\/NEU.0000000000003644","article-title":"Positive preprocedure depression screening is associated with worse outcomes after single-level posterior-only lumbar fusion: a retrospective cohort analysis","volume":"98","author":"Xu","year":"2026","journal-title":"Neurosurgery"}],"container-title":["Frontiers in Human Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1860063\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:46:37Z","timestamp":1781156797000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2026.1860063\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,11]]},"references-count":19,"alternative-id":["10.3389\/fnhum.2026.1860063"],"URL":"https:\/\/doi.org\/10.3389\/fnhum.2026.1860063","relation":{},"ISSN":["1662-5161"],"issn-type":[{"value":"1662-5161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,11]]},"article-number":"1860063"}}