Introduction: One method for ascertaining quality in cervical spine surgery is through patient-reported outcomes (PROs). The present study seeks to define the relationship between preoperative patient factors and their effect on predicting changes in PROs.
Methods: Since September 2009, all preoperative patients evaluated in the University of Chicago Spine Clinic were asked to complete a questionnaire evaluating PROs. Collected data included baseline, 3, 6, 12 and 24 months postoperative. Instruction and data collection were performed separately by an individual apart from the medical team. Surgeons were blinded to the results. Prospectively collected data included NDI, SF-36 PCS and MCS scores, age, etiology, and surgery type. Seventeen co-morbidities were collected retrospectively from patients’ charts. Bivariate and multivariate analysis was performed on differences between scores preoperatively to 3 months and 3 to 12 months.
Results: 221 patients were evaluated at the Spine Clinic for cervical pathology. 108 patients underwent surgery and responded preoperatively, 3 months, and 12 months postoperative. These responders comprised 88% of all patients receiving cervical spine surgery who had potential for 1-year followup. Multivariate analysis demonstrates that patient age (p=.038) and cardiac history(p=.05) were negatively correlated with NDI score improvement preoperatively to 3 months. These factors did not correlate with score differences between 3 and 12 months (age, p=.586; cardiac, p=.289). BMI(p=.006), lung disease(.003), and renal insufficiency(p=.003) were associated with lower improvements in SF-36 PCS score baseline to 3 months. With the 3 to 12 month difference, BMI (p=.167), lung disease (p=.626), and renal insufficiency (p=.794) don’t correlate. History of psychiatric illness(p=.006) correlated negatively with improvement in MCS score from baseline-3 months but not from 3-12 months (p=.11).
Conclusions: Age and several medical co-morbidities are associated with worse outcome at 3 months, but not at 12 months of follow up.
Patient Care: This research will allow surgeons to better understand their patients' short term and long term perception of cervical spine surgery. Also, with more research, it may be easier to predict a patients' improvement post-surgery based on their preoperative factors with a higher degree of accuracy. Thus, patients can receive more tailored information on what to expect after their surgery.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the importance of patient co-morbidities in predicting outcomes in cervical spine surgery
2) Discuss, in small groups interpretation of PROs
3) Identify the potential of PROs in clinical practice
References: Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A, Massicotte EM, Fehlings MG: Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases. J Neurosurg Spine 14:348–355, 2011
Cleland JA, Fritz JM, Whitman JM, Palmer JA: The Reliability and Construct Validity of the Neck Disability Index and Patient Specific Functional Scale in Patients With Cervical Radiculopathy. Spine 31:598–602, 2006
Pearson A, Lurie J, Tosteson T, Zhao W, Abdu W, Weinstein J: Who Should Have Surgery for Spinal Stenosis? Spine:2012