Pre-operative expectations of patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

Abstract

BACKGROUNDDespite an abundance of literature on degenerative cervical myelopathy (DCM), little is known about pre-operative expectations of these patients. PURPOSEThe primary objective was to describe patient pre-operative expectations. Secondary objectives included identifying patient characteristics associated with high pre-operative expectations and to determine if expectations varied depending on myelopathy severity. STUDY DESIGNThis was a retrospective study of a prospective multicenter, observational cohort of patients with DCM. PATIENT SAMPLEPatients who consented to undergo surgical treatment between January 2019 and September 2022 were included. OUTCOMES MEASURESAn 11-domain expectation questionnaire was completed pre-operatively whereby patients quantified the expected change in each domain. METHODSThe most important expected change was captured. A standardized expectation score was calculated as the sum of each expectation divided by the maximal possible score. The high expectation group was defined by patients who had an expectation score above the 75th percentile. Predictors of patients with high expectations were determined using multivariable logistic regression models. RESULTSThere were 262 patients included. The most important patient expectation was preventing neurological worsening (40.8%) followed by improving balance when standing or walking (14.5%), improving independence in everyday activities (10.3%), and relieving arm tingling, burning and numbness (10%). Patients with mild myelopathy were more likely to select no worsening as the most important expected change compared to patients with severe myelopathy (p<.01). Predictors of high patient expectations were: having fewer comorbidities (OR -0.30 for every added comorbidity, 95% CI -0.59 to -0.10, p=.01), a shorter duration of symptoms (OR 0.92, 95% CI 0.35–1.19, p=.02), no contribution from “failure of other treatments” on the decision to undergo surgery (OR 1.49, 95% CI 0.56–2.71, p=.02) and more severe neck pain (OR 0.19 for 1 point increase, 95% CI 0.05–0.37, p=.01). CONCLUSIONSMost patients undergoing surgery for DCM expect prevention of neurological decline, better functional status, and improvement in their myelopathic symptoms. Stopping neurological deterioration is the most important expected outcomes by patients.