155. Dual role of neck disability index in assessment of quality of life in cervical spine patients

Abstract

<h3>BACKGROUND CONTEXT</h3> Neck disability index (NDI) is a reliable measure for disability in patients with cervical myeloradiculopathy. Few studies have examined the relationship between NDI and mental health outcomes following anterior cervical discectomy and fusion (ACDF). <h3>PURPOSE</h3> To determine the correlation between NDI and mental health outcome measures following ACDF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> A total of 225 patients undergoing primary, single or multi-level ACDF procedures. <h3>OUTCOME MEASURES</h3> Demographic and perioperative characteristics, NDI, 12-Item Short Form Mental Component Summary (SF-12 MCS) and Patient Health Questionnaire-9 (PHQ-9) <h3>Methods</h3> A prospectively maintained surgical registry was retrospectively reviewed for consecutive elective ACDF procedures from December 2013 to December 2019. Inclusion criteria were patients undergoing elective, primary, single or multi-level ACDF. Procedures indicated for infectious, traumatic or malignant etiologies were excluded. Demographic characteristics such as age, gender, body mass index (BMI), ethnicity, smoking and diabetic status, and insurance type were collected preoperatively. Medical comorbidities and classifications were preoperatively collected as American Society of Anesthesiologists physical classification (ASA) and Charlson comorbidity index (CCI). Preoperative characteristics including spinal pathology, operative time, blood loss, length of postoperative stay and day of discharge were also collected. Primary outcomes of interest were NDI and mental health outcome measures, SF-12 MCS and PHQ-9. Outcomes were collected at the preoperative timepoint as well as postoperative timepoints (6-weeks, 12-weeks, 6-months, 1-year, 2-years). Postoperative improvement for all outcomes was evaluated using a paired Student's t-test. Correlations between NDI and mental health outcomes were evaluated using Pearson's correlation analysis. Strength of association was determined using the following criteria: weak (0.1 ≤ |r| < 0.3); moderate (0.3 ≤ |r| < 0.5); strong (|r| ≥ 0.5). <h3>Results</h3> A total of 225 patients were included in this study. Mean age was 49.8 years with majority being male (57.8%) and nonobese (60.0%). Majority of patients had a single level procedure (55.6%), a spinal pathology of recurrent herniated nucleus pulposus (79.1%) and had a mean procedure time of 56.1 minutes, length of stay of 13.9 hours, and were typically discharged by postoperative day 0. NDI demonstrated significant improvements through 2-years compared to preoperative baseline values (all p<0.001). Similarly, SF-12 MCS and PHQ-9 significantly improved through 1-year postoperatively (all p≤0.010), but was not maintained at 2-years (p=0.835; p=0.128). NDI demonstrated a significant but moderate correlation with SF-MCS at the preoperative timepoint (|r| = 0.447), but a strong correlation was observed at all postoperative timepoints (all p≤0.001). A significant and strong correlation between NDI and PHQ-9 was demonstrated at all timepoints (all p≤0.002). <h3>Conclusions</h3> NDI demonstrated significant and strong correlations with mental health outcome measures at all postoperative timepoints. NDI is an effective measure to assess neck disability from cervical myeloradiculopathy, but it may also capture the impact on mental health following ACDF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.