Impact of Predominant Arm Pain vs Neck Pain on 12-Month Outcomes Following Elective Cervical Spine Surgery: Analysis From the Quality Outcomes Database (QOD)

Abstract

Abstract INTRODUCTION The impact of the type of pain presentation on outcomes of spine surgery remains elusive. The severity of symptoms is a critical determinant for decision to operate among such patients. Herein, we present an analysis of the impact of predominant symptom location (arm pain vs neck pain) on postoperative improvement in patient reported outcomes. METHODS The Quality Outcomes Database (QOD) cervical spine registry was queried for patients undergoing 1 to 2 level ACDF for degenerative spine disease. Multivariable (MV) regression was performed to assess the impact of predominant pain location (arm pain vs neck pain vs equal arm and neck pain) on the following 12 mo outcomes following surgery-NASS satisfaction, Neck Disability Index (NDI) and return to work. RESULTS A total of 9277 patients were included in the final analysis. Of these, 18.4% (n = 1705) presented with predominant arm pain, 32.3% (n = 2994) presented with predominant neck pain, and 49.3% (n = 4578) presented with equal neck and arm pain. On MV analysis, patients with predominant neck pain were found to have lower odds of being satisfied at 1 yr following surgery (OR = 0.73, CI: 0.62-0.98, P < .001) while predominant arm pain was not significantly associated (OR = 1.04, CI: 0.6-1.4, P = .55, ref = equal neck and arm pain). On MV linear regression, patients with predominant neck pain had higher (worse) 12 mo NDI (Coef: 0.24, CI: 0.15-0.33, P < .0001) while predominant arm pain was not significantly associated with 12 mo NDI. Predominant arm pain (OR = 0.77, CI:0.64-1.02, P = .06) or neck pain (OR = 1.04, CI: 0.82-1.33, P = .6) were not significantly associated with return to work at 1 yr. CONCLUSION Analysis from a national spine registry suggests predominant pain location (arm pain vs neck pain) might be a significant determinant of improvement in functional outcomes and patient satisfaction following anterior cervical discectomy and fusion for degenerative spine disease.