https://orcid.org/0000-0003-1400-8436
Figures
Abstract
Background
Lumbar degenerative disc disease (DDD) is a prevalent musculoskeletal disorder characterized by significant pain, disability, and reduced quality of life. Depression frequently coexists with chronic pain conditions, intensifying symptoms and complicating management. Despite its clinical relevance, the prevalence of depression specifically among patients with lumbar DDD remains inadequately understood.
Aim
This systematic review and meta-analysis aimed to assess the prevalence of depression among patients with lumbar DDD and to identify potential sources of heterogeneity.
Methods
A comprehensive literature search was conducted using PubMed, Web of Science, ScienceDirect, Academic Search Complete, and Google Scholar to identify relevant studies published between 2015 and 2022. Studies reporting the prevalence of depression among patients with lumbar DDD were included in the analysis. Pooled prevalence estimates were calculated using random-effects models, and subgroup analyses were performed to investigate sources of heterogeneity.
Results
Seven studies met the inclusion criteria, encompassing 3485 patients with lumbar DDD. The pooled prevalence of depression was estimated at 20.19% (95% CI 8.94–39.46%). Subgroup analyses revealed significant variations in prevalence estimates across different geographic regions and assessment tools. Sensitivity analyses confirmed the robustness of the findings, while meta-regression analyses did not identify significant associations between prevalence rates and factors such as age or year of publication.
Conclusions
This study highlights a substantial burden of depression among patients with lumbar DDD, emphasizing the need for comprehensive mental health assessment and management in this population. The findings contribute to a better understanding of the psychological comorbidities associated with lumbar DDD and have implications for clinical practice and future research.
Citation: Li K, Dzhumabekov A, Dyusembekov Y, Nurbakyt A, Glushkova N (2025) The prevalence of depression in patients with lumbar degenerative disk disease: A systematic review and meta-analysis. PLoS One 20(5): e0322123. https://doi.org/10.1371/journal.pone.0322123
Editor: Svenja Illien-Jünger, Emory University School of Medicine, UNITED STATES OF AMERICA
Received: August 23, 2024; Accepted: March 17, 2025; Published: May 7, 2025
Copyright: © 2025 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
The intervertebral disc undergoes biochemical changes and dehydration as part of the normal aging process [1]. Additionally, both macro and micro traumas contribute to the natural degeneration of the disc over time [1]. The lumbar spine’s susceptibility to degeneration may be attributed to the evolutionary transition to bipedalism and an upright posture [2]. Lumbar degenerative disk disease (DDD) affects both sexes equally and does not always present with symptoms [3,4]. However, by the age of 50, more than 85% of the population exhibits changes associated with disc degeneration [4]. DDD represents a significant health burden, contributing substantially to back pain and radiculopathy, which can lead to disability, decreased quality of life, and increased healthcare costs [5,6]. Coexisting with these painful conditions, depression has been identified as a prevalent comorbidity [7].
Depression, recognized as a global health priority, constitutes a substantial portion of the global non-fatal disease burden[8]. Evidence indicates that depression is associated with increased pain, greater disability, and prolonged recovery in patients with chronic lower back pain [9,10]. Moreover, understanding the intricate relationship between physical and psychological factors in lumbar DDD patients is essential for optimizing treatment outcomes and enhancing overall well-being. Research suggests that depression can exacerbate pain perception, reduce functional capacity, and hinder responsiveness to conventional treatments [11]. Conversely, effective management of depressive symptoms has been associated with improved pain control, functional status, and overall treatment satisfaction in chronic pain populations [12]. Therefore, elucidating the prevalence of depression among lumbar DDD patients not only sheds light on the extent of the mental health burden in this population but also underscores the importance of integrated, multidisciplinary approaches to patient care. By addressing both the physical and psychological aspects of the condition, healthcare providers can implement more holistic and effective management strategies, ultimately improving patient outcomes and quality of life [13]. A clear understanding of the prevalence of depression among lumbar DDD patients is, therefore, essential for ensuring comprehensive and targeted disease management.
Although a meta-analysis of published literature reports a pooled prevalence rate of depression among degenerative spine disease patients at 30.8%, substantial variations exist due to differences in assessment methods, sample sizes, and patient populations [7]. Furthermore, no comprehensive meta-analysis has systematically examined the prevalence of depression specifically in patients with lumbar DDD.
The primary objective of this study was to investigate the prevalence of depression among patients with lumbar DDD through a systematic review of the published literature. Additionally, the study aimed to identify potential sources of heterogeneity using subgroup analysis, meta-regression analysis, and sensitivity analysis. This study aims to offer a more comprehensive understanding of depression prevalence among lumbar DDD patients, which is crucial for guiding interventions to prevent and manage mental health disorders in this population.
Materials and methods
The study protocol is registered with the PROSPERO International Prospective Register of Systematic Reviews CRD42024489684.
Search strategy
The PROSPERO database was searched to identify registrations of similar studies, but no were found. Subsequently, a search was conducted in five major electronic literature databases: PubMed, Web of Science, ScienceDirect, Academic Search Complete, and Google Scholar. The literature search in the specified sources was initiated on January 15, 2023, and completed on March 7, 2024. The search strategy included the following keywords: “depression”; “depressive disorder”; “degenerative disk disease”; “degenerative disk”; and “prevalence”. The full strategy is presented in the supplementary materials (S1 Table).
Eligibility criteria
Methodologically, the literature screening and synthesis followed the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two authors (K.L. & Y.K.D.) independently performed the literature screening. The inclusion criteria for the studies: (a) full-text publications in peer-reviewed journals; (b) studies reporting data on patients with lumbar degenerative disc disease (DDD); (c) studies reporting depression identified through a validated self-report questionnaire. The exclusion criteria for the studies: (a) studies evaluating the psychometric properties of instruments; (b) studies including all patients with spinal degenerative diseases or presenting data on patients undergoing certain types of surgeries without specifying the population; (c) studies with duplicative data; (d) studies reporting only the number of patients with clinically diagnosed depression or those receiving antidepressant treatment; (e) studies reporting mean scores on the psychometric questionnaire but not the prevalence of depression among DDD patients.
Selection of studies and data extraction
The identified publications underwent deduplication followed by primary (title + abstract) and eligibility (full text) reviews. Subsequently, full-text examination, review, and data extraction were performed, with each step resulting to the exclusion of publications based on predefined inclusion and exclusion criteria. Following the PRISMA guidelines, two authors (K.L. & Y.K.D.) independently extracted the following information from the identified full-text articles using a standardized data extraction form. The data of interest included: 1) first author’s name, 2) publication year, 3) country, 4) study design, 5) sample size, 6) lesion location, 7) number of females, 8) number of smokers, 9) mean age, 10) type of work (physical, intellectual), 11) depression prevalence, 12) Visual Analogue Scale (VAS) scores, 13) assessment method and criteria, and 14) Oswestry Disability Index (ODI) scores. Any disagreements between the authors were resolved through consensus, with a discussion involving the third author (N.G.).
Risk of bias
The Critical Appraisal Skills Programme (CASP) Qualitative Research Checklist was used to evaluate the methodological quality of the included studies [14]. This checklist comprised ten questions covering various aspects, including the study’s objectives, methodology, research design, recruitment approach, data collection methods, researcher-participant relationships, ethical considerations, data analysis, research findings, and overall value. Each criterion was assessed with a rating of ‘yes’ when adequately described (scored as 1), ‘no’ when absent (scored as 0), and ‘can’t tell’ when unclear or incomplete (scored as 0.5). Total scores ranged from 0 to 10, with a score of at least 7 indicating satisfactory quality.
Statistical analysis
The pooled mean depression prevalence with 95% confidence intervals (95% CI) was calculated using random-effects model for meta-analysis in RStudio software [15]. Forest plots were used to display the pooled estimates. Heterogeneity across studies was assessed using the I²-statistic. Sensitivity analysis was conducted to investigate which study significantly influences the pooled prevalence estimates. Additionally, meta-regression analyses were performed for age and baseline survey year. Subgroup analysis was carried out to explore sources of heterogeneity, stratifying studies by region, ODI scores, VAS scores, and assessment method. Publication bias was evaluated through visual inspection of a drapery plot and statistical analysis using Egger’s test, examining potential asymmetry in the distribution of study results.
Results
A thorough search across PubMed, Web of Science, ScienceDirect, Academic Search Complete, and Google Scholar databases yielded 775 records. Initial screening reduced this number to 744 non-duplicative records, from which 80 full-text articles underwent evaluation. Among these studies, 13 presented mean depression scale scores without providing information on the number of patients involved [16–28], and six studies presented the prevalence of clinically diagnosed depression [29–34]. Ultimately, seven articles met the inclusion criteria for the systematic review. The study selection process is illustrated in Fig 1 [35]. A detailed table of the study selection process is presented in Supplementary S2 Table.
Description of included studies and subjects
The study designs and characteristics of patients are presented in Table 1. All the studies were published between 2015 and 2022. Four studies were conducted in Europe, two in the Middle East, and one in Asia. Most of the studies were prospective, with only one being retrospective. A total of 3485 patients with lumbar DDD were included in seven studies (mean sample size = 497.86 patients, range = 51–1505 patients). The mean age of the participants ranged from 42.7 to 58.3 years. The proportion of female participants ranged from 43% to 70%. Three studies did not report ODI and VAS scores. Four studies used the Beck Depression Inventory (BDI), two studies used the Zung Self-Rating Depression Scale (ZDS), and one study used the 12-Item Short Form Survey (SF-12). A detailed data extraction table is provided in Supplementary S3 Table.
The risk of bias assessment
The risk of bias assessment results are presented in Table 2. All the studies had low risk of bias with a CASP score above 8.5.
Prevalence rate
Based on the random-effects model, the pooled prevalence estimate of seven studies on depression in lumbar DDD patients, either before operative treatment or on conservative therapy, was 20.19% (535/3485 participants; [95% CI 8.94–39.46%]). The test for heterogeneity indicated high heterogeneity: I2 = 99%, Q (df = 6)=487.25, p-value<0.001 (Fig 2).
Abbreviations: C.I.: confidence interval.
Sensitivity analysis
Sequential exclusion of individual studies in a sensitivity analysis assessed the robustness of the pooled estimate. The results revealed persistent heterogeneity, but the pooled prevalence estimate remained stable (S3 Fig). Additionally, the leave-one-out study analysis identified the Mertimo 2022 study as the most influential, with its results presented in the supplemental materials (Fig 3).
Meta-regression results
Random-effects multivariate meta-regressions were performed to explore the source of heterogeneity. Meta-regression analyses based on age and year of publication did not demonstrate a statistically significant association (p values for the model of 0.64 and 0.12, respectively). This is likely due to low power and the small number of available studies and should not be interpreted as evidence of no effect of age or year on depression prevalence. Meta-regression results are available in the supplemental materials (S1 Fig and S2 Fig).
Subgroup analysis
To explore potential sources of heterogeneity, subgroup analyses were conducted in each subgroup. Statistically significant differences in prevalence estimates were detected with high heterogeneity across the studies, including comparisons between regions (Asia vs. Middle East vs. Europe): (12.55% [95% CI 10.36–15.12%] vs 25.85% [95% CI 4.90–70.21%] vs 19.97% [95% CI 6.15–48.70%] I2 = 99.33, p < 0.01). Other subgroup analyses included comparisons based on ODI scores: ODI ≥ 50 vs. ODI score <50 vs. ODI score not reported 27.54% [95% CI 5.69–70.54%] I2 = 99.40 vs 13.21% [95% CI 2.29–49.74%] I2 = 99.43 vs 21.12% [95% CI 5.60–54.73%] I2 = 99.12, p < 0.01); studies with VAS scores: VAS ≥ 6 vs. VAS score <6 vs. VAS score not reported 12.95% [95% CI 3.83–35.70%] I2 = 86.93 vs 50.13% [95% CI 7.65–72.25%] vs 21.10% [95% CI 6.87–49.24%] I2 = 99.12, p < 0.01); and studies using ZDS vs. BDI vs. SF-12 9.56% [95% CI 2.10–34.29%] I2 = 87.63 vs 20.66% [95% CI 8.15–46.29%] I2 = 98.69 vs 50.13% [95% CI 45.09–55.18%], p < 0.01) (Table 3). Additional visualization of the results is presented in the supplemental materials (S4–S7 Figs).
Publication bias assessment
Upon visual inspection of the drapery plot (Fig 4), no evident asymmetry was observed, suggesting a relatively symmetric distribution of study results around the estimated effect size. This finding was further confirmed by Egger’s test for publication bias, which yielded non-significant results (p = 0.93). The absence of asymmetry in the drapery plot, coupled with the non-significant Egger’s test, suggests minimal evidence of publication bias in the meta-analysis of lumbar DDD studies. These findings enhance confidence in the robustness and validity of the meta-analytic results.
Discussion
The meta-analysis revealed a significant pooled prevalence of depression among lumbar DDD patients, whether preoperatively or during conservative treatment, at 20.19%. This finding highlights a notable burden of depressive symptoms within this demographic. Recognizing the potential benefits of preoperative depression management in alleviating postoperative pain intensity, recurrence, and opioid misuse [29,33], underscores the critical need to scrutinize the high incidence of preoperative depression diagnosis. Consequently, there is an imperative for integrating comprehensive psychological assessments and interventions into the preoperative care regimen. Such an approach is pivotal in bolstering both physical and mental health outcomes among lumbar DDD patients.
The effectiveness of antidepressants in managing patients with lower back pain and DDD further supports our findings on the high prevalence of depression among lumbar DDD patients. A recent systematic review of clinical practice guidelines indicates that antidepressants are the most recommended class of medications among the eleven guidelines analyzed [43]. Additionally, a meta-analysis of nine randomized clinical trials confirms the efficacy of duloxetine in managing nonspecific chronic back pain, not only in pain relief but also in improving quality of life [44]. While surgical treatment of lumbar DDD significantly reduces pain at three months post-operatively, its effect on depression symptoms is limited [45]. Postoperative outcome measures after lumbar spine surgery indicate that patients with depression exhibit worse disease severity both before and after surgery; however, they also show a higher potential for improvement in disability, pain, and physical function [46].
Our study findings underscore the importance of critically defining the study population when interpreting results in comparison with similar studies. Notably, Chen et al. (2021) reported a substantial prevalence of depressive symptoms among individuals with degenerative spine disease at 30.8% (7). However, our study found a lower prevalence rate, possibly due to the specificity of focusing solely on lumbar DDD patients, a smaller sample size, and the use of higher cut-off scores for depression diagnosis used in the included studies. The exclusion of patients with cervical DDD was based on well-established differences, not only in disease location but also in symptomatology, functional impact, complications, treatment modalities, and potentially, depression prevalence when compared to lumbar DDD patients [47,48].
Acknowledging the regional focus of the included studies, primarily on European and Middle Eastern populations, is crucial, as it may limit the generalizability of findings to other geographic regions. The lack of postoperative assessment data in our study prevents the evaluation of depressive symptom progression following operative treatment. Additionally, our exclusion criteria aimed to reduce heterogeneity by excluding patients with clinically diagnosed depression, those on antidepressant treatment, or those self-reporting as depressed, focusing solely on self-report questionnaire results.
Despite efforts to reduce bias, variability in depression assessment tools and cutoff scores across studies may have influenced the pooled prevalence estimate and introduced heterogeneity. This variability underscores the need for standardization in assessment protocols to enhance the comparability of findings across studies.
In conclusion, our study provides valuable insights into the prevalence of depression among lumbar DDD patients. The high prevalence of depression underscores the necessity for comprehensive psychological assessment and management in this population, including the use of antidepressants when appropriate. Future research should address identified limitations, such as the need for more diverse study populations, postoperative assessment data, and standardized assessment protocols, to inform targeted interventions that address both physical and mental health outcomes in this population.
Supporting information
S3 Table. Comprehensive data extraction details.
https://doi.org/10.1371/journal.pone.0322123.s016
(XLSX)
S1 Fig. Meta-regression analysis based on the mean age of participants.
https://doi.org/10.1371/journal.pone.0322123.s002
(TIF)
S2 Fig. Meta-regression analysis based on the year of publication.
https://doi.org/10.1371/journal.pone.0322123.s003
(TIF)
S4 Fig. Subgroup analysis of depression prevalence in lumbar DDD patients by region.
https://doi.org/10.1371/journal.pone.0322123.s005
(TIF)
S5 Fig. Subgroup analysis of depression prevalence in lumbar DDD patients by ODI score category.
https://doi.org/10.1371/journal.pone.0322123.s006
(TIF)
S6 Fig. Subgroup analysis of depression prevalence in lumbar DDD patients by VAS score category.
https://doi.org/10.1371/journal.pone.0322123.s007
(TIF)
S7 Fig. Subgroup analysis of depression prevalence in lumbar DDD patients by assessment scale.
https://doi.org/10.1371/journal.pone.0322123.s008
(TIF)
S1 File. PRISMA 2020 checklist for systematic review.
https://doi.org/10.1371/journal.pone.0322123.s011
(DOCX)
Acknowledgments
We acknowledge Meruyert Suleimenova, PhD, for her technical assistance in this manuscript.
References
- 1. Roh JS, Teng AL, Yoo JU, Davis J, Furey C, Bohlman HH. Degenerative disorders of the lumbar and cervical spine. Orthop Clin North Am. 2005;36(3):255–62. pmid:15950685
- 2. Scarcia L, Pileggi M, Camilli A, Romi A, Bartolo A, Giubbolini F, et al. Degenerative disc disease of the spine: from anatomy to pathophysiology and radiological appearance, with morphological and functional considerations. J Pers Med. 2022;12(11):1810. pmid:36579533
- 3. Omid-Fard N, Thornhill RE, Torres C, Almansoori TM, Rush CAE, Glikstein R. MRI markers of degenerative disc disease in young patients with multiple sclerosis. Can Assoc Radiol J. 2024;75(1):136–42. pmid:37339165
- 4. Modic MT, Masaryk TJ, Ross JS, Carter JR. Imaging of degenerative disk disease. Radiology. 1988;168(1):177–86. pmid:3289089
- 5. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028–37. pmid:22231424
- 6. Honarpisheh P, Parker SL, Conner CR, Anjum S, Stark JR, Quinn JC, et al. 20-year inflation-adjusted medicare reimbursements (years: 2000-2020) for common lumbar and cervical degenerative disc disease procedures. Global Spine J. 2024;14(1):211–8. pmid:35609345
- 7. Chen Z, Luo R, Yang Y, Xiang Z. The prevalence of depression in degenerative spine disease patients: a systematic review and meta-analysis. Eur Spine J. 2021;30(12):3417–27. pmid:34476597
- 8. Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull. 2017;143(8):783–822. pmid:28447828
- 9. Wolf JC, Kaul A, Anwar FN, Roca AM, Khosla I, Loya AC, et al. Do six-week postoperative patient-reported outcomes predict long-term clinical outcomes following lumbar decompression? World Neurosurg. 2024.
- 10. Wong JJ, Tricco AC, Côté P, Liang CY, Lewis JA, Bouck Z, et al. Association between depressive symptoms or depression and health outcomes for low back pain: a systematic review and meta-analysis. J Gen Intern Med. 2022;37(5):1233–46. pmid:34383230
- 11. Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119–32. pmid:15033151
- 12. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163(20):2433–45. pmid:14609780
- 13. Unützer J, Carlo AC, Arao R, Vredevoogd M, Fortney J, Powers D, et al. Variation in the effectiveness of collaborative care for depression: does it matter where you get your care? Health Aff (Millwood). 2020;39(11):1943–50. pmid:33136506
- 14.
CASP. CASP Checklist for Cross-Sectional Studies, 2017. Critical Appraisal Skills Programme, UK 2017.
- 15. Posit team. RStudio: Integrated Development Environment for R. Posit Software, PBC 2023. http://www.posit.co/ (accessed January 22, 2024).
- 16. Jankowski R, Misterska E, Latuszewska J, Bogajewska B, Glowacki J. Differences in beliefs about pain control after surgery due to lumbar or cervical discopathy and degenerative spine disease. J Back Musculoskelet Rehabil. 2019;32(5):779–95. pmid:30814344
- 17. Celenlıoglu AE, Sencan S, Gunduz OH. Does facet tropism negatively affect the response to transforaminal epidural steroid injections? A prospective clinical study. Skeletal Radiol. 2019;48(7):1051–8. pmid:30603772
- 18. Wu B, Tian X, Shi C, Jiang C, Zhang J, Zhan G, et al. Clinical outcomes of “U” route transforaminal percutaneous endoscopic lumbar discectomy in chronic pain patients with lumbar spinal stenosis combined with disc herniation. Pain Res Manag. 2021;2021:6657463. pmid:33532011
- 19. Falavigna A, Righesso O, Traynelis VC, Teles AR, da Silva PG. Effect of deep wound infection following lumbar arthrodesis for degenerative disc disease on long-term outcome: a prospective study: clinical article. J Neurosurg Spine. 2011;15(4):399–403. pmid:21682558
- 20. Misterska E, Jankowski R, Głowacki M. Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control. Med Sci Monit. 2013;19:1211–20. pmid:24370564
- 21. Hattapoğlu E, Batmaz İ, Dilek B, Karakoç M, Em S, Çevik R. Efficiency of pulsed electromagnetic fields on pain, disability, anxiety, depression, and quality of life in patients with cervical disc herniation: a randomized controlled study. Turk J Med Sci. 2019;49(4):1095–101. pmid:31385489
- 22. Palada V, Ahmed AS, Finn A, Berg S, Svensson CI, Kosek E. Characterization of neuroinflammation and periphery-to-CNS inflammatory cross-talk in patients with disc herniation and degenerative disc disease. Brain Behav Immun. 2019;75:60–71. pmid:30248387
- 23. Yazici Sacaklidir G, Sencan S, Sacaklidir R, Gunduz OH. The effect of spinopelvic parameters on transforaminal epidural steroid injection treatment success in lumbar disc herniation. Int J Clin Pract. 2021;75(11):e14708. pmid:34370361
- 24. Comella K, Silbert R, Parlo M. Effects of the intradiscal implantation of stromal vascular fraction plus platelet rich plasma in patients with degenerative disc disease. J Transl Med. 2017;15(1):12. pmid:28086781
- 25. Lotzke H, Brisby H, Gutke A, Hägg O, Jakobsson M, Smeets R, et al. A person-centered prehabilitation program based on cognitive-behavioral physical therapy for patients scheduled for lumbar fusion surgery: a randomized controlled trial. Phys Ther. 2019;99(8):1069–88. pmid:30951604
- 26. Bernstein DN, Merchan N, Fear K, Rubery PT, Mesfin A. Greater socioeconomic disadvantage is associated with worse symptom severity at initial presentation in patients seeking care for lumbar disc herniation. Spine (Phila Pa 1976). 2021;46(7):464–71. pmid:33181773
- 27. Yüksel A, Çetinkaya F, Karakoyun A. The effect of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk herniation. Perspect Psychiatr Care. 2021;57(1):335–42. pmid:32596823
- 28. Nguyen C, Boutron I, Baron G, Sanchez K, Palazzo C, Benchimol R, et al. Intradiscal glucocorticoid injection for patients with chronic low back pain associated with active discopathy: a randomized trial. Ann Intern Med. 2017;166(8):547–56. pmid:28319997
- 29. 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’ compensation setting. Spine (Phila Pa 1976). 2015;40(22):1775–84. pmid:26192725
- 30. Corenman DS, Gillard DM, Dornan GJ, Strauch EL. Recombinant human bone morphogenetic protein-2-augmented transforaminal lumbar interbody fusion for the treatment of chronic low back pain secondary to the homogeneous diagnosis of discogenic pain syndrome: two-year outcomes. Spine (Phila Pa 1976) 2013;38: E1269–77.
- 31. Budiono GR, McCaffrey MH, Parr WCH, Choy WJ, Singh T, Pelletier MH, et al. Development of a multivariate prediction model for successful oswestry disability index changes in L5/S1 anterior lumbar interbody fusion for degenerative disc disease. World Neurosurg. 2021;148:e1–9. pmid:33189919
- 32. Kao Y-C, Chen J-Y, Chen H-H, Liao K-W, Huang S-S. The association between depression and chronic lower back pain from disc degeneration and herniation of the lumbar spine. Int J Psychiatry Med. 2022;57(2):165–77. pmid:33840233
- 33. Suri P, Pearson AM, Zhao W, Lurie JD, Scherer EA, Morgan TS, et al. Pain recurrence after discectomy for symptomatic lumbar disc herniation. Spine (Phila Pa 1976). 2017;42(10):755–63. pmid:27584678
- 34. Gordon AM, Golub IJ, Ng MK, Lam AW, Houten JK, Saleh A. Primary and revision cervical disc arthroplasty from 2010-2020: patient demographics, utilization trends, and health care reimbursements. World Neurosurg. 2022;168:e344–9. pmid:36220494
- 35. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. pmid:33782057
- 36. Wang H, Zhang D, Ma L, Shen Y, Ding W. Factors predicting patient dissatisfaction 2 years after discectomy for lumbar disc herniation in a Chinese older cohort: a prospective study of 843 cases at a single institution. Medicine (Baltimore). 2015;94(40):e1584. pmid:26448005
- 37. Engel-Yeger B, Keren A, Berkovich Y, Sarfaty E, Merom L. The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation. Disabil Rehabil. 2018;40(3):302–8. pmid:27866425
- 38. Jabłońska R, Ślusarz R, Królikowska A, Haor B, Antczak A, Szewczyk M. Depression, social factors, and pain perception before and after surgery for lumbar and cervical degenerative vertebral disc disease. J Pain Res. 2017:89–99.
- 39. Stienen MN, Smoll NR, Joswig H, Snagowski J, Corniola MV, Schaller K, et al. Influence of the mental health status on a new measure of objective functional impairment in lumbar degenerative disc disease. Spine J. 2017;17(6):807–13. pmid:27988343
- 40. Telli H, Hüner B, Kuru Ö. Determination of the prevalence from clinical diagnosis of sacroiliac joint dysfunction in patients with lumbar disc hernia and an evaluation of the effect of this combination on pain and quality of life. Spine (Phila Pa 1976) 2020;45:549–54.
- 41. Biczo A, Bereczki F, Koch K, Varga PP, Genodisc Consortium, Lazary A. Genetic variants of interleukin 1B and 6 are associated with clinical outcome of surgically treated lumbar degenerative disc disease. BMC Musculoskelet Disord. 2022;23(1):774. pmid:35964023
- 42. Mertimo T, Karppinen J, Niinimäki J, Blanco R, Määttä J, Kankaanpää M, et al. Association of lumbar disc degeneration with low back pain in middle age in the Northern Finland Birth Cohort 1966. BMC Musculoskelet Disord. 2022;23(1):359. pmid:35428226
- 43. Price MR, Mead KE, Cowell DM, Troutner AM, Barton TE, Walters SA, et al. Medication recommendations for treatment of lumbosacral radiculopathy: a systematic review of clinical practice guidelines. PM R. 2024;16(10):1128–42. pmid:38629664
- 44. Leão Nunes Filho MJ, Barreto ESR, Antunes Júnior CR, Alencar VB, Falcão Lins-Kusterer LE, Azi LMT de A, et al. Efficacy of antidepressants in the treatment of chronic nonspecific low back pain: a systematic review and meta-analysis. Pain Manag. 2024;14(8):437–51. pmid:39377458
- 45. Karibayeva I, Kuanyshbekov Y, Idayat M, Turdaliyeva B, Makhanbetkhan S. Depression and pain dynamics in lumbar degenerative disk disease: a systematic review and meta-analysis. Acta Biomedica. 2024;95:e2024165–75.
- 46. Javeed S, Benedict B, Yakdan S, Saleem S, Zhang JK, Botterbush K, et al. Implications of preoperative depression for lumbar spine surgery outcomes: a systematic review and meta-analysis. JAMA Netw Open. 2024;7(1):e2348565. pmid:38277149
- 47.
Fakhoury J, Dowling TJ. Cervical degenerative disc disease. Treasure Island (FL): Stat Pearls; 2020.
- 48. Saleem S, Aslam HM, Rehmani MAK, Raees A, Alvi AA, Ashraf J. Lumbar disc degenerative disease: disc degeneration symptoms and magnetic resonance image findings. Asian Spine J. 2013;7(4):322–34. pmid:24353850