231. Influence of preoperative severity on postoperative improvement among patients with myeloradiculopathy following anterior cervical discectomy and fusion

Abstract

<h3>BACKGROUND CONTEXT</h3> Few studies have investigated how neck pain and disability improve differently among patients with symptoms of both myelopathy and radiculopathy. <h3>PURPOSE</h3> To determine how neck pain and disability improve following anterior cervical discectomy and fusion (ACDF) among patients with myeloradiculopathy. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> This study included 187 eligible patients undergoing primary, elective, single or multilevel ACDF. <h3>OUTCOME MEASURES</h3> Demographics, perioperative information, and patient-reported outcome measures (PROM) were collected. PROMs included visual analog scale (VAS) neck and arm, neck disability index (NDI), 12-Item Short Form physical composite score (SF-12 PCS), Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF), and Patient Health Questionnaire 9 (PHQ-9). <h3>METHODS</h3> A surgical database was reviewed for primary, elective, single or multilevel ACDF. Demographics, perioperative information, and patient-reported outcome measures (PROM) were collected. PROMs included visual analog scale (VAS) neck and arm, neck disability index (NDI), 12-Item Short Form physical composite score (SF-12 PCS), Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF), and Patient Health Questionnaire 9 (PHQ-9). PROMs were collected preoperatively and postoperatively. Patients were categorized according to preoperative symptom severity: High VAS arm (>7); High NDI (>55); High VAS arm and NDI; and moderate symptoms. Demographics and perioperative information for groups were tested for independence using chi-squared analysis or t-test. Impact of preoperative symptom severity on PROM scores and magnitude of change were assessed using linear regression. Achievement of a minimum clinically important difference (MCID) was calculated for all groups using established values. Impact of preoperative symptoms on MCID achievement was determined using logistic regression. Alpha value was adjusted for multiple testing using a Bonferroni correction. <h3>RESULTS</h3> Of 187 eligible patients, there were 14 with High NDI, 46 with High VAS arm, 29 with High NDI and VAS arm, and 98 with neither high VAS arm or NDI. Mean age was 50.2 years, average BMI was 29.4 and 61.0% were male. Insurance collected was the only significant demographic between groups (p=0.014). No significant differences in perioperative characteristics were demonstrated. Preoperative VAS neck, VAS arm, NDI, SF-12 PCS, PROMIS PF, and PHQ-9 significantly differed by group (all p<0.001). Symptom severity had a significant impact on postoperative VAS neck (all time points; p<0.002), VAS arm (6-weeks; p=0.007), NDI (6 weeks to 6 months; p<0.001), SF-12 PCS (6 months; p=0.004), PROMIS PF (6 weeks; p=0.007), and PHQ-9 (6 weeks and 6 months; p<0.001). Magnitude of improvement at all postoperative time points differed by severity groups for VAS arm, NDI, and VAS neck, except at 1 year (all p<0.002). Overall MCID achievement differed by symptom severity for VAS neck and arm, and NDI (p<0.005). MCID achievement demonstrated significant differences between groups at intermittent timepoints for VAS arm (all time points), VAS neck (6 weeks), and NDI (6 months) (all p<0.002). MCID achievement for physical function PROMs and PHQ-9 were not significantly different. <h3>CONCLUSIONS</h3> Patients with myeloradiculopathy demonstrated significant differences in PROM scores based on severity of preoperative symptoms. PROM improvement and MCID achievement for neck disability, neck pain, and arm pain were the only values that differed based on symptom severity. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.