P30. Effect of multiple sclerosis on elective spine surgical outcomes

Abstract

<h3>BACKGROUND CONTEXT</h3> Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease that can lead to significant functional disability. Improving treatment regimens have extended life expectancy and led to an increase in the number of elective spine surgeries for degenerative conditions in the MS population. Recent literature has suggested higher rates of complications after elective spine surgery among patients with MS; however, there is a paucity of literature comparing postoperative patient reported outcomes (PROs) and reoperation rates between patients with MS and the general population. <h3>PURPOSE</h3> To determine if patients with MS have worse PROs and higher reoperation, complication and readmission rates after elective spine surgery compared to the general population when adjusting for baseline covariates through propensity matching. <h3>STUDY DESIGN/SETTING</h3> A retrospective review of prospectively collected data from the Quality Outcomes Database (QOD), a national, longitudinal, multicenter spine outcomes registry, was performed. <h3>PATIENT SAMPLE</h3> For the lumbar cohort, 312 patients with MS and 46,738 patients without MS were included. The cervical myelopathy cohort included 91 patients with MS and 6,426 patients without MS. The cervical radiculopathy cohort consisted of 103 patients with MS and 13,751 patients without MS. <h3>OUTCOME MEASURES</h3> Outcomes included: 1) reoperation, 2) complications, 3) readmissions, 4) PROs at 3- and 12-months including NDI, ODI, NRS back/arm/leg pain, mJOA scores and patient satisfaction ratings, 5) Qaly scores at 12 months. <h3>METHODS</h3> Data from the QOD was queried between 04/2013-01/2019. Three surgical groups were included: 1) Elective lumbar surgery, 2) Elective cervical surgery for myelopathy, 3) Elective cervical surgery for radiculopathy. Patients with any neurodegenerative condition other than MS were excluded. Patients without MS were propensity matched against patients with MS in a 5 to 1 ratio without replacement based on ASA grade, arthrodesis, surgical approach, number of operated levels, age, baseline ODI, NRS leg/arm pain, NRS back pain and EQ5D. Regressions with cluster-robust standard errors were used to estimate average effect of how the outcome would change if the MS patient didn't have the disease. The mean difference was used for continuous outcomes and the risk difference was used for binary outcomes. <h3>RESULTS</h3> For the lumbar cohort, no differences were found between the two groups at 3 or 12 months in any of thefour outcomes. For the myelopathy cohort, multivariable regression revealed that MS patients had a lower rate of reoperation at 12 months (risk difference=-0.036, p=0.007) but worse 3-month mJOA scores (mean difference=-1.044, p=0.004) compared to the control group. For the radiculopathy cohort, multivariable regression revealed that MS patients had a lower rate of reoperation at 3 (risk difference=-0.019, p=0.018) and 12 (risk difference=-0.029, p=0.007) months compared to the control group. <h3>CONCLUSIONS</h3> Patients with MS had similar PROs compared to the general population when adjusting for baseline covariates through propensity matching, except for 3-month mJOA scores in the myelopathy cohort. Reoperation rates were found to be lower in patients with MS undergoing elective cervical surgery for both myelopathy and radiculopathy. These results demonstrate that MS does not significantly affect the outcomes of elective spine surgery, and in some cases, MS patients had a lower rate of reoperation in cervical spine surgery. MS therefore should not represent a major contraindication to surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.