218. Baseline NDI and PROMIS PF predict postoperative return to normal in cervical spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Predicting which patients will benefit from cervical spine surgery remains a clinical challenge. While a number of studies have examined postoperative improvement in degenerative cervical disease, the proportion of patients who return to normal remains unknown. <h3>PURPOSE</h3> To assess whether preoperative patient-reported outcomes (PROs) can be used to predict which patients return to normative levels after cervical spine surgery. <h3>STUDY DESIGN/SETTING</h3> Prospective cohort. <h3>PATIENT SAMPLE</h3> Adult patients undergoing cervical spine surgery, excluding those undergoing surgery for instability due to trauma. <h3>OUTCOME MEASURES</h3> Correlation of baseline PROs with achieving postoperative normative and acceptable symptoms states. <h3>METHODS</h3> Patients undergoing cervical spine surgery between 2016-2018 were prospectively enrolled, completing questionnaires (Neck Disability Index [NDI] and Patient Reported Outcomes Measurement Information System [PROMIS] Pain Interference [PI] and Physical Function [PF]) preoperatively and at 6 months postoperatively. Logistic regression analysis was used to determine the association between preoperative outcome measures and achieving postoperative patient acceptable symptom state (PASS) for NDI and the normative mean (50) for PROMIS. <h3>RESULTS</h3> A total of 139 patients met inclusion criteria, with a mean age of 56.4 years and diagnoses of myelopathy (n=36), radiculopathy (n=48) and myeloradiculopathy (n=49). Overall, NDI and PROMIS PF demonstrated a statistically significant correlation between worse baseline scores and achieving postoperative PASS (NDI) and the PROMIS normative mean, while the association for PROMIS PI did not reach statistical significance. For NDI, a one-point worsening in the preoperative score resulted in OR of achieving PASS (NDI ≤ 17) of 0.96 (p<0.001). This association held true for patients with radiculopathy (OR 0.96; p=0.022) but did not reach statistical significance for patients with myelopathy (OR 0.98; p=0.35). For PROMIS PF, a one-point increase in the preoperative score resulted in OR of achieving the normative mean (PROMIS ≥ 50) of 1.10 (p<0.001). This association held true for patients with radiculopathy (OR 1.14; p=0.033) but did not reach statistical significance for patients with myelopathy (OR 1.03; p=0.515). When stratified by baseline level of disability, the proportion of patients reaching PASS was 83%, 100%, 80%, 57%, and 52% for baseline NDI 0-4, 5-15, 15-24, 25-34, and >34, respectively. For PROMIS PF, the proportion of patients reaching the normative threshold was 62%, 46%, 30%, 33%, and 26% for baseline PF 47.7-66.2, 43.3-47.2, 40.1-43.1, 34.7-40.0, and 23.5-34.6, respectively. <h3>CONCLUSIONS</h3> Preoperative PROs can predict postoperative benefit for patients undergoing cervical spine surgery, with worse baseline function associated with a lower likelihood of attaining PASS for NDI and the PROMIS PF normative mean. PROMIS PI did not demonstrate this correlation and may not be as useful as a predictor of postoperative outcome. These data will better enable surgeons and patients to estimate prognosis after cervical spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.