Observational studyEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
New-onset depression following anterior cervical discectomy and fusion or cervical artificial disc replacement: a retrospective cohort study using a multi-institutional claims database.
Observational study in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePsychological outcomes after cervical spine surgery remain underexplored, particularly the development of new-onset depression. This study aimed to compare the long-term incidence of new-onset depression following anterior cervical discectomy and fusion (ACDF) versus cervical artificial disc replacement (ADR), hypothesizing that motion preservation with ADR may be associated with a lower risk of postoperative depression.
methodsWe conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including patients who underwent ACDF or ADR between 2005 and 2020. Patients with pre-existing mood disorders or prior antidepressant use were excluded. A 1:1 propensity score matching was performed based on demographics and baseline comorbidities. New-onset depression was identified using ICD-10 diagnoses and/or antidepressant prescriptions. Time-to-event analyses were conducted using Kaplan-Meier curves, and hazard ratios (HRs), absolute risk differences, and numbers needed to treat (NNTs) were calculated.
resultsAt 5-year follow-up, ADR was associated with a significantly lower incidence of new-onset depression compared with ACDF (HR, 0.79; 95% CI, 0.72-0.87). The absolute risk difference was - 5.2%, corresponding to an NNT of 19. Consistent results were observed across alternative depression definitions.
conclusionIn this large real-world cohort, ADR was associated with a modest but clinically meaningful reduction in the risk of new-onset depression compared with ACDF. These findings are hypothesis-generating and should be interpreted with caution given the observational design and the potential for residual confounding. Further prospective studies incorporating patient-reported outcomes are warranted.
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