Patient-Reported Outcomes for Lumbar Fusion in Patients with Previously Treated Cervical Myelopathy

Abstract

Patients with a history of surgically treated cervical myelopathy and lumbar pathology requiring fusion present complex challenges, and literature describing patient-reported outcomes in this cohort beyond patients with tandem spinal stenosis is sparse. This has led to unclear guidelines in the literature. We present the first dataset comparing patient-reported outcomes for lumbar fusion in patients with isolated lumbar pathology versus patients with a history of surgically treated cervical myelopathy. In this retrospective cohort study of a prospectively collected lumbar fusion database, variables of interest included demographics, comorbidities, type and levels of fusion, Oswestry Disability Index (ODI), and minimal clinically important difference. Of 325 patients identified, 309 met inclusion criteria. Of these, 29 patients had previous cervical surgery to address cervical myelopathy. Median time between cervical and lumbar surgery was 4.0 years (range, 0.3-19.7). There was no statistical difference in preoperative ODI score (24.8 vs. 25.6, P= 0.687), 6-month postoperative ODI score (17.3 vs. 18.7, P= 0.459), change in ODI score (7.5 vs. 6.9, P= 0.673), or minimal clinically important difference for ODI score (62.1% vs. 58.6%, P= 0.710) in patients who had undergone cervical surgery versus patients who had not. Patients with a history of previously treated cervical myelopathy have a similar rate of clinically relevant improvement after lumbar fusion compared with patients without such history. As such, these patients appear to benefit from lumbar fusion surgery to the same degree as patients without a history of surgically treated cervical myelopathy.