225. Severity of cervical disc degeneration and health-related quality of life outcomes following anterior cervical discectomy and fusion

Abstract

BACKGROUND CONTEXT Cervical disc degeneration is a common radiographic finding among patients with cervical spine pathology. While not all patients with radiographic evidence of disc degeneration are symptomatic, there has been little literature exploring the relationship between severity of cervical disc degeneration and postoperative health-related quality of life (HRQOL) outcomes in patients following anterior cervical discectomy and fusion (ACDF). PURPOSE The purpose of this study was to explore the relationship between the severity of cervical disc degeneration and postoperative HRQOL outcomes in patients’ status post one- to three-level ACDFs. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A cohort of patients status post ACDF with available preoperative/postoperative cervical radiographic imaging was obtained using Standardized Query Language (SQL) of a hospital database from a single-center, high-volume academic hospital from January 2013 to December 2018. OUTCOME MEASURES The primary outcomes of interest were HRQOL outcomes: Short Form-12 Physical/Mental Component Scores (SF-12 PCS/MCS), neck disability index (NDI), and visual analog scale arm/neck scores (VAS Arm/Neck). METHODS Patient demographics and case characteristics were obtained via SQL query and electronic medical record (EMR) chart reviews. HRQOL outcomes were obtained via SQL query with at least 1-year follow-up. Cervical disc degeneration was graded using a previously established scoring system incorporating: middle intervertebral disc height loss, anterior osteophyte length, and endplate sclerosis. Patients were then categorized into mild, moderate, or severe degeneration groups. Statistical analysis was performed with regression to examine the relationship between severity of disc degeneration and patient/clinical outcomes. RESULTS Of the 211 patients in the final cohort, 27 had mild degeneration, 100 moderate degeneration and 84 severe degeneration. Univariate analysis showed a significantly higher age in patients with severe disc degeneration compared to mild and moderate (58.4 vs 55.5 vs 52.5; p: 0.034). among HRQOL outcomes, patients with severe disc degeneration reported significant improvement in SF-12 PCS (9.4 vs 3.6 vs 4.9; p: 0.024) and VAS neck scores (-4.6 vs -2.6 vs -3.8; p: 0.036). This was further supported with multiple linear regression analysis, showing significant improvement in SF-12 PCS (β: 3.59; p: 0.005) and VAS neck (β: -1.13; p: 0.005) scores in the severe degeneration group when compared with the mild and moderate disc degeneration groups. Patients among all three groups showed significant improvement in SF-12 PCS, NDI, VAS neck, and VAS arm scores after surgical intervention. CONCLUSIONS Overall, our data validates that patients suffering from preoperative severe disc degeneration report the greatest improvement in symptoms and functional status when compared to patients with mild and moderate disease. Cervical disc degeneration has been meticulously studied at a basic science level, however clinical data regarding its effect on patient clinical outcomes has been lacking. Our study provides evidence that the preoperative degree of cervical disc degeneration has a significant effect on postoperative patient-reported outcomes, and discussion of these findings can help physicians and patients make informed decisions during the preoperative period. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.