254. Pain catastrophizing impacts outcome scores but not recovery kinetics after 1-2 level anterior cervical surgery

Abstract

BACKGROUND CONTEXT For a subset of patients who catastrophize pain, communication of symptoms/disability is a challenge for themselves and for practitioners to interpret. PURPOSE To determine if patients that catastrophize pain had worse clinical outcomes after anterior cervical surgery. STUDY DESIGN/SETTING Retrospective review of prospectively collected data. PATIENT SAMPLE All patients who underwent 1- or 2-level anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR) for cervical radiculopathy and/or myelopathy and had 1-year follow-up were included in our study. OUTCOME MEASURES Patient-reported Outcome Measures (PROMs) - health related quality of life scores (HRQOLs), including Neck Disability Index (NDI), Short-Form 12 Physical Component Score (SF-12 PCS), Short-Form 12 Mental Component Score (SF-12 MCS), PROMIS Physical Function score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores were collected prospectively pre- and postoperatively (2 weeks, 6 weeks, 12 weeks, 6 months, 1 year). METHODS Patients with preoperative VAS-neck or VAS-arm score of 9-10/10 were classified as pain catastrophizing (PC cohort) and the rest as non-pain catastrophizing (non-PC cohort). HRQOLs were compared between cohorts at all time points. We compared recovery kinetics between the PC versus non-PC cohorts. This was done by normalizing all HRQOLs at each interval time point. The area under the curve (AUC) was then calculated for a plot of the normalized score versus follow-up time point as has been done in previous studies (IHS, Integrated Health State). A Mann-Whitney test or student's t-test was used to compare mean values from the two cohorts based upon whether data was normally distributed. RESULTS Forty-eight patients with a mean age of 50.0±11.8 years and comprised of 22 females were included. All patients had a minimum of 1-year follow-up. There were 13 patients in the PC cohort. There were no significant differences in age, gender and preoperative radiographic parameters. Preop VAS-arm, VAS-neck, SF-12 PCS, SF-12 MCS, NDI and PROMIS were all worse for the PC cohort (p CONCLUSIONS Our findings demonstrate that patients that catastrophize pain may have worse overall outcome scores after anterior cervical surgery (ACDF or CDR). After normalizing their outcome scores, we demonstrated that PC patients have similar rates of improvement after ACDF or CDR. Pain catastrophizing patients might communicate pain in a more extreme manner, but clinicians should counsel these patients that outcomes are positive after ACDF or CDR. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.