Asian Spine J.  2019 Dec;13(6):1036-1046. 10.31616/asj.2018.0237.

Antidepressants in Spine Surgery: A Systematic Review to Determine Benefits and Risks

• Bayoumi AB
• Ikizgul O
• Karaali CN
• Bozkurt S
• Konya D
• Toktas ZO

• KMID: 2467436
• DOI: http://doi.org/10.31616/asj.2018.0237

Abstract

Antidepressant drugs can be advantageous in treating psychiatric and non-psychiatric illnesses, including spinal disorders. However, spine surgeons remain unfamiliar with the advantages and disadvantages of the use of antidepressant drugs as a part of the medical management of diseases of the spine. Our review article describes a systematic method using the PubMed/Medline database with a specific set of keywords to identify such benefits and drawbacks based on 17 original relevant articles published between January 2000 and February 2018; this provides the community of spine surgeons with available cumulative evidence contained within two tables illustrating both observational (10 studies; three cross-sectional, three case-control, and four cohort studies) and interventional (seven randomized clinical trials) studies. While tricyclic antidepressants (e.g., amitriptyline) and duloxetine can be effective in the treatment of neuropathic pain caused by root compression, venlafaxine may be more appropriate for patients with spinal cord injury presenting with depression and/or nociceptive pain. Despite the potential associated consequences of a prolonged hospital stay, higher cost, and controversial reports regarding the lowering of bone mineral density in the elderly, antidepressants may improve patient satisfaction and quality of life following surgery, and reduce postoperative pain and risk of delirium. The preoperative treatment of preexisting psychiatric diseases, such as anxiety and depression, can improve outcomes for patients with spinal cord injury-related disabilities; however, a preoperative platelet function assay is advocated prior to major spine surgical procedures to protect against significant intraoperative blood loss, as serotonergic antidepressants (e.g., selective serotonin reuptake inhibitors) and bupropion can increase the likelihood of bleeding intraoperatively due to drug-induced platelet dysfunction. This comprehensive review of this evolving topic can assist spine surgeons in better understanding the benefits and risks of antidepressant drugs to optimize outcomes and avoid potential hazards in a spine surgical setting.

Keyword

Spine surgery; Clinical outcomes; Antidepressive agents; Systematic review

MeSH Terms

Aged
Antidepressive Agents*
Antidepressive Agents, Tricyclic
Anxiety
Blood Platelets
Bone Density
Bupropion
Case-Control Studies
Cohort Studies
Delirium
Depression
Duloxetine Hydrochloride
Hemorrhage
Humans
Length of Stay
Methods
Neuralgia
Nociceptive Pain
Pain, Postoperative
Patient Satisfaction
Quality of Life
Risk Assessment*
Serotonin
Spinal Cord
Spinal Cord Injuries
Spine*
Surgeons
Venlafaxine Hydrochloride
Antidepressive Agents
Antidepressive Agents, Tricyclic
Bupropion
Duloxetine Hydrochloride
Serotonin
Venlafaxine Hydrochloride