Arm Pain Scores Research Articles

Functional results and unfavorable events after treatment of proximal humerus fractures using a new locking plate system

BackgroundProximal humerus fractures are often treated with a fixed-angle titanium plate osteosynthesis. Recently, plates made of alternative materials such as carbon fibre-reinforced polyetheretherketone (CFR-PEEK) have been introduced. This study presents the postoperative results of patients treated with a CFR-PEEK plate.MethodsPatients with proximal humerus fractures treated with a CFR-PEEK plate (PEEKPower™ Humeral Fracture Plate (HFP)) were included. In follow-up examination, age and gender adjusted Constant-Murley Score (ACS), Subjective Shoulder Value (SSV), Quick Disabilities of the Arm, Shoulder and Hand Score (QDASH) and pain score (Visual Analog Scale (VAS)) were analyzed. General condition at follow-up was measured by European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L). Range of motion was recorded. In addition, radiographs at follow-up, unfavorable events and revision rate were analyzed.ResultsIn total, 98 patients (66.0 ± 13.2 years, 74 females, 24 males) were reexamined. Mean follow-up was 27.6 ± 13.2 months. There were 15 2-part, 28 3-part and 55 4-part fractures. The functional scores showed good results: SSV 83.3 ± 15.6%, QDASH 13.1 ± 17.0 and ACS 80.4 ± 16.0. A 4-part-fracture, head split component, nonanatomic head shaft reposition and preoperative radiological signs of osteoarthritis were significant negative predictors for poorer clinical scores. Unfavourable events were observed in 27 patients (27.6%). Revision surgery was performed in 8 (8.2%) patients. Risk factors for an unfavourable event were female gender, age of 50 years and older, diabetes, affected dominant hand, 4-part fracture, head split and preoperative radiological signs of osteoarthritis.ConclusionThere are several advantages of the CFR-PEEK plate (PEEKPower™ Humeral Fracture Plate (HFP)) such as the polyaxial screw placement and higher stability of locking screws. In summary, the CFR-PEEK plate osteosynthesis is a good alternative with comparable clinical results and some biomechanical advantages. Proximal humerus fractures show good clinical results after treatment with a CFR-PEEK plate. The revision rate and the risk of unfavorable events are not increased compared to conventional titanium plate osteosynthesis.Level of evidenceIV

Clinical significance of the C2 slope after multilevel cervical spine fusion.

The C2 slope (C2S) is one of the parameters that can determine cervical sagittal alignment, but its clinical significance is relatively unexplored. This study aimed to evaluate the clinical significance of the C2S after multilevel cervical spine fusion. A total of 111 patients who underwent multilevel cervical spine fusion were included in this study. The C2S, cervical sagittal vertical axis (cSVA), C2-7 lordosis, and T1 slope (T1S) were measured in standing lateral cervical spine radiographs preoperatively and 2 years after the surgery. Clinical outcome measures were visual analog scale (VAS) neck and arm pain scores, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scale score, and patient-reported subjective improvement rate (IR) percentage. Statistical analysis was performed using a paired-samples t-test and Pearson's correlation, and a receiver operating characteristic (ROC) curve to determine the cutoff values of C2S. C2S demonstrated a significant correlation with the cSVA, C2-7 lordosis, T1S, and T1S minus cervical lordosis. C2S revealed a significant correlation with the JOA, neck pain VAS, and NDI scores at 2 years after surgery. Change in the C2S correlated with postoperative neck pain and NDI scores. ROC curves demonstrated the cutoff values of C2S as 18.8°, 22.25°, and 25.35°, according to a cSVA of 40 mm, severe disability expressed by NDI, and severe myelopathy, respectively. C2S can be an additional cervical sagittal alignment parameter that can be a useful prognostic factor after multilevel cervical spine fusion.

Treatment of Trigger finger by ultrasound-guided needle release of a1 pulley: A series of 105 cases.

We aimed to evaluate the efficacy and tolerance of A1 pulley release using the needle technique, under ultrasound guidance, in patients with symptomatic trigger finger. All patients with symptomatic trigger finger underwent A1 pulley release using an intramuscular 21 gauge (G) needle. Quinnell grade (I-IV), Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) score (0-100) and pain score on a visual analog scale (VAS: 0-10mm) were recorded at inclusion. The primary endpoint was complete resolution of the trigger finger at 6 months. Eighty-four patients totaling 105 treated digits were included. Mean age was 63.3±10.7 years. Prior to treatment, mean VAS pain score was 5.8±2.6mm, and mean QuickDASH score was 44.3±19.1. At 6 months, disappearance of symptoms was achieved in 85 of 91 digits with follow-up (93.4%), and in 85.7% at 12 months. The absolute reduction in VAS pain and QuickDASH scores at 6 months was respectively 4.1±3.1 (P<0.001) and 36.1±20.7 (P<0.001), and 90% of patients reported being satisfied or very satisfied at 6 months. Long duration of symptoms was significantly associated with persistent trigger finger at 6 months after intervention. Complications were rare and minor. Tenosynovitis occurred in 5.7% of cases, for which a corticosteroid injection into the tendon sheath rapidly led to favorable resolution. Treatment of trigger finger by release of the A1 pulley under ultrasound guidance using the needle technique is a mildly invasive technique that yields rapid and effective symptom resolution with good tolerance up to 12 months.

Minimally invasive posterior cervical foraminotomy versus anterior cervical discectomy and fusion for cervical radiculopathy: a meta-analysis.

With the recent development of minimally invasive techniques, minimally invasive posterior cervical foraminotomy (MIS-PCF) has become increasingly popular as a minimally invasive method to treat cervical radiculopathy. However, there are still controversies about whether MIS-PCF is superior to anterior cervical discectomy and fusion (ACDF). The purpose of this study is to evaluate the therapeutic effects of MIS-PCF and ACDF on unilateral cervical radiculopathy without myelopathy. We searched PubMed, Embase, the Cochrane Library, and Scopus comprehensively using the terms related to MIS-PCF. Two reviewers independently evaluated the potential studies, and extracted and analyzed the data of operation time, hospital stay, neck disability index (NDI) score, visual analog scale for neck pain (VAS-neck) and arm pain (VAS-arm) scores, reoperation rate, and complications. Seven studies with 1175 patients were included. The study population was 53.5% male, with a mean age of 48.9. MIS-PCF presented a significantly shorter postoperative hospitalization time compared to ACDF, while the operation time, complication/reoperation rate, and VAS-arm, VAS-neck, and NDI scores were comparable between the two cohorts. In North America, the average cost of MIS-PCF is lower than ACDF. Thus, we suggest that MIS-PCF is an alternative to ACDF for selected patients.

Prospective, multicenter study of 2-level cervical arthroplasty with a PEEK-on-ceramic artificial disc.

The purpose of this study was to evaluate the safety and efficacy of a PEEK-on-ceramic cervical total disc replacement (cTDR) device for the treatment of 2-level cervical disc disease with radiculopathy and/or myelopathy. The study was a prospective, nonrandomized, historically controlled FDA investigational device exemption trial evaluating the Simplify Cervical Artificial Disc for use at 2 levels. The anterior cervical discectomy and fusion (ACDF) control group was derived from a propensity score-matched (using subclassification) cohort of patients who participated in an earlier prospective trial in which similar indications were used. The follow-up duration was 24 months. The primary outcome was a 4-point composite success classification. Other validated clinical and radiographic assessments were also evaluated. The investigational group (n = 182) was compared with patients who underwent ACDF (n = 170) in a historical control group using propensity score analysis. The overall composite success rate was statistically significantly greater in the cTDR group compared with the ACDF group (86.7% vs 77.1%; p < 0.05). The mean Neck Disability Index scores improved significantly in both groups, with cTDR significantly lower at some follow-up points. At the 24-month follow-up, a minimum 15-point improvement in Neck Disability Index scores was achieved in 92.9% of the cTDR group and 83.5% of the ACDF group (p > 0.05). In both groups, neck and arm pain scores improved significantly (p < 0.05) by 6 weeks and improvement was maintained throughout follow-up. Segmental range of motion was maintained at both treated segments in the cTDR group. MRI performed in the cTDR group at 24 months postoperatively found minimal changes in facet joint degeneration. The rate of subsequent surgical intervention was 2.2% in the cTDR group and 8.8% in the ACDF group. This study adds to the growing body of literature supporting cTDR for 2-level cervical disc disease with radiculopathy or myelopathy. cTDR showed a superior overall success rate compared to ACDF, while maintaining motion. These results support that the Simplify disc is a viable alternative to ACDF in appropriately selected patients with 2-level cervical spondylosis.

227. Prospective, randomized, blinded clinical trial comparing PEEK and allograft spacers in patients undergoing ACDF surgeries

BACKGROUND CONTEXT The biomechanical qualities as well as osteoconductive, osteogenic and osteoinductive properties of various graft materials have been previously evaluated. There remain questions, however as to whether there are any clinical and/or radiographic outcome differences in the selection of interbody graft types for ACDF. PURPOSE The main objective of the study was to examine clinical and radiological outcomes in patients undergoing ACDF surgeries randomized to receive either PEEK or structural bone allografts. STUDY DESIGN/SETTING A prospective, randomized, blinded clinical trial was initiated at a single center. PATIENT SAMPLE A total of 120 patients were enrolled and randomized. OUTCOME MEASURES All patients were followed for 2 years ± 2 months; radiographic and clinical outcomes were assessed at 3, 6, 12 and 24 months with an additional follow-up at 3 weeks for radiographic assessment. METHODS Patients undergoing one- to three-level ACDF with single anterior plate fixation were randomized (1:1 ratio) to receive either cortical allograft or PEEK interbody spacers. RESULTS Comparing clinical outcomes, no differences in arm or neck pain scores were noted, however there was a statistically significant (< 0.041) improvement in SF-36 PCS scores for the allograft group at all follow-up time points and a tendency towards lower disability scores. Overall, evidence of radiographic fusion was achieved in 87 (91.6%) patients: five (10.2%) and three (6.5%) patients had pseudoarthrosis (p=0.72) in the PEEK and allograft groups, respectively. At 24 months follow-up time, any cervical or segmental alignment restoration achieved with surgery was lost and no statistically significant changes were detected when all levels of surgery were included. Likewise, there were no statistically significant differences between the groups for anterior or posterior body height measurements at the 24 months follow-up. Approximately 20% of patients had anterior and posterior subsidence, all grade 0 regardless of the group assignment. CONCLUSIONS Comparable radiographic outcomes were observed for patients undergoing one- to three-level PEEK vs allograft-assisted ACDF surgeries. There was a tendency for improved clinical outcomes in the allograft patient group. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. The biomechanical qualities as well as osteoconductive, osteogenic and osteoinductive properties of various graft materials have been previously evaluated. There remain questions, however as to whether there are any clinical and/or radiographic outcome differences in the selection of interbody graft types for ACDF. The main objective of the study was to examine clinical and radiological outcomes in patients undergoing ACDF surgeries randomized to receive either PEEK or structural bone allografts. A prospective, randomized, blinded clinical trial was initiated at a single center. A total of 120 patients were enrolled and randomized. All patients were followed for 2 years ± 2 months; radiographic and clinical outcomes were assessed at 3, 6, 12 and 24 months with an additional follow-up at 3 weeks for radiographic assessment. Patients undergoing one- to three-level ACDF with single anterior plate fixation were randomized (1:1 ratio) to receive either cortical allograft or PEEK interbody spacers. Comparing clinical outcomes, no differences in arm or neck pain scores were noted, however there was a statistically significant (< 0.041) improvement in SF-36 PCS scores for the allograft group at all follow-up time points and a tendency towards lower disability scores. Overall, evidence of radiographic fusion was achieved in 87 (91.6%) patients: five (10.2%) and three (6.5%) patients had pseudoarthrosis (p=0.72) in the PEEK and allograft groups, respectively. At 24 months follow-up time, any cervical or segmental alignment restoration achieved with surgery was lost and no statistically significant changes were detected when all levels of surgery were included. Likewise, there were no statistically significant differences between the groups for anterior or posterior body height measurements at the 24 months follow-up. Approximately 20% of patients had anterior and posterior subsidence, all grade 0 regardless of the group assignment. Comparable radiographic outcomes were observed for patients undergoing one- to three-level PEEK vs allograft-assisted ACDF surgeries. There was a tendency for improved clinical outcomes in the allograft patient group.

Prospective, Randomized, Blinded Clinical Trial Comparing PEEK and Allograft Spacers in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgeries.

Prospective, randomized, blinded clinical trial. To examine clinical and radiological outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF) surgeries randomized to receive either polyether-ether-ketone (PEEK) or structural bone allografts. The biomechanical qualities as well as osteoconductive, osteogenic, and osteoinductive properties of various graft materials have been previously evaluated. There remain questions, however, as to whether there are any clinical and/or radiographic outcome differences in the selection of interbody graft types for ACDF. Patients undergoing one- to three-level ACDF with single anterior plate fixation were randomized (1:1 ratio) to receive either cortical allograft or PEEK interbody spacers. Radiographic and clinical outcomes were assessed at 3, 6, 12, and 24 months with an additional postoperative radiographic assessment. A total of 120 patients were enrolled and randomized. Comparing clinical outcomes, no differences in arm or neck pain scores were noted; however, there was a statistically significant (≤0.041) improvement in SF-36 PCS scores for the allograft group at all follow-up time points and a tendency toward lower disability scores. Overall, evidence of radiographic fusion was achieved in 87 (91.6%) patients: five (10.2%) and three (6.5%) patients had pseudoarthrosis (P = 0.72) in the PEEK and allograft groups, respectively. At 24 months' follow-up time, any cervical or segmental alignment restoration achieved with surgery was lost and no statistically significant changes were detected when all levels of surgery were included. Likewise, there were no statistically significant differences between the groups for anterior or posterior body height measurements at the 24 months' follow-up. Approximately 20% of patients had anterior and posterior subsidence, all grade 0 regardless of the group assignment. Comparable radiographic outcomes were observed for patients undergoing one- to three-level PEEK versus allograft-assisted ACDF surgeries. Although MCID comparisons suggest that allograft and PEEK-treated patients have similar clinical outcomes, testing that incorporates the magnitude of the change suggests that there may be a statistically significant greater magnitude of improvement for the allograft group patients, but further studies with a larger sample size would be helpful to determine if a true effect exists.

Cervical Alignment Analysis Comparing Two-Level Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion with Anterior Plate Fixation

This study assesses cervical alignments after 2-level cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) with anterior plate fixation. Eighty-two patients who underwent 2-level CDA or ACDF in 2014-2019 were identified. Cervical alignment parameters were compared between the 2 cohorts. Subgroup analyses were performed to determine factors that differentiate alignment outcomes between the 2 procedures. Although both cohorts achieved significant focal lordosis (FL) and overall cervical lordotic (CL) gains, CDA cohorts achieved significantly greater 12-month FL gain (P= 0.022). However, in a multivariate analysis controlling for preoperative variables, FL gain was no longer significant. Although the CDA cervical sagittal vertical axis (cSVA) significantly improved at 3 (P= 0.030) and 12 (P= 0.007) months, these improvements were not superior to the ACDF cSVA. Male patients undergoing CDA achieved greater 12-month CL gain. Patients undergoing CDA with body mass index >25 kg/m2 achieved greater 12-month FL gain. Patients undergoing CDA with symptom duration >12 months achieved greater FL gain at 3 and 12 months. Patients undergoing CDA with high baseline T1 slope or cSVA achieved greater 12-month cSVA reduction. Clinical outcomes were comparable between the 2 cohorts. Unlike the ACDF group, CL gain in the CDA group was significantly correlated with the cSVA reduction, which was associated with significant improvement in the Neck Disability Index, arm pain, and 12-Item Short-Form Mental Component Scores. Heterotopic ossification was not found to significantly affect patient outcome and cervical alignment in both cohorts. ACDF and CDA are viable options for 2-level degenerative disc disease in carefully selected patients. Both approaches produced equivalent postoperative alignment changes in a 2-level operation.

What's New in Spine Surgery.

What's New in Spine Surgery.

Neck Disability at Presentation Influences Long-Term Clinical Improvement for Neck Pain, Arm Pain, Disability, and Physical Function in Patients Undergoing Anterior Cervical Discectomy and Fusion

To compare perioperative characteristics, patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) achievement after anterior cervical discectomy and fusion (ACDF) in patients stratified by preoperative neck disability. The Neck Disability Index (NDI) assesses a patient's self-perceived neck disability and is often used to assess the efficacy of cervical surgical intervention. Our study (a retrospective cohort study) evaluates how preoperative severity of patient neck disability influences postoperative clinical improvement after ACDF. Primary, single-level, or multilevel ACDF procedures were included. PROMs were administered at preoperative/6 week/12 week/6 month/1 year/2 year time points and included Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), visual analog scale (VAS) for neck and arm pain, NDI, and 12-Item Short-Form (SF-12) Physical Composite Score (PCS). Patients were grouped according to preoperative NDI <50 (mild to moderate neck disability) or NDI ≥50 (severe neck disability). Demographics/perioperative characteristics/postoperative complications/mean PROMs/MCID achievement rates were compared using χ2 or Student t test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired-samples t test. MCID achievement was determined by comparing ΔPROMs with established thresholds. A total of 225 patients were included, 150 NDI <50 and 75 NDI ≥50. The NDI ≥50 cohort was significantly younger (P= 0.002). Cohorts did not differ for spinal disease/operative duration/estimated blood loss/postoperative length of stay/postoperative narcotic consumption/adjacent segment disease rate/1-year arthrodesis rate/6-month pseudarthrosis rate. Postoperative VAS pain score on postoperative day 0 and 1 was significantly increased in the NDI ≥50 cohort (P<0.048, all). Postoperative complication rates did not differ. All mean PROMs differed at all time points (P<0.043, all). The NDI <50 patient cohort significantly improved from preoperative baseline for all PROMs and time points except SF-12 PCS/Patient-Reported Outcome Measurement Information System-Physical Function at 6 weeks. The NDI ≥50 cohort significantly improved for all PROMs and time points except SF-12 PCS at 6 weeks. The NDI ≥50 cohort showed a greater proportion achieving MCID for NDI at 6 weeks/2 years/overall (P<0.037, all). Both cohorts showed significant long-term clinical improvement for neck pain/arm pain/physical function/neck disability, although patients with severe preoperative neck disability reported inferior mean scores for these outcomes at all time points.

Do Inflammatory Cytokines Affect Patient Outcomes After ACDF?

Prospective cohort study. The aim was to determine the relationship between serum inflammatory mediators, preoperative cervical spine disease severity, and clinical outcomes after anterior cervical discectomy and fusion (ACDF). Given the role of the inflammatory cascade in spinal degenerative disease, it has been hypothesized that inflammatory markers may serve as a predictor of patient outcomes after surgery. All patients over age 18 who underwent ACDF for cervical spondylosis with associated radiculopathy and/or myelopathy between 2015 and 2017 from a single institution were prospectively recruited. Preoperative serum inflammatory markers including interleukin (IL)-6, IL-8, tumor necrosis factor-α, high-mobility group box-1 (HMGB1), and white blood cells were measured and correlated to patient demographics, surgical characteristics, duration of symptoms, previous opioid use, and preoperative and 1-year postoperative patient-reported outcomes measures (PROMs) including the neck disability index (NDI), visual analog scale neck pain, visual analog scale arm pain, and Physical and Mental Component Scores of the Short Form-12 (PCS and MCS, respectively) using spearman's rho coefficient. A total of 77 patients were enrolled with follow-up PROMs available for 62% (n=48) of patients at a minimum of 1-year after ACDF. The absolute concentrations of IL-6 and tumor necrosis factor-α were found to be weakly correlated with one another (ρ=0.479). Preoperative symptoms lasting <1-year were weakly correlated with elevation in HMGB1 (ρ=0.421). All other patient demographics exhibited negligible correlation with the preoperative inflammatory markers. Lower preoperative PCS (ρ=0.355) and higher preoperative NDI (ρ=0.336) were weakly correlated with elevated HMGB1. Lower MCS (ρ=0.395) and higher NDI (ρ=0.317) preoperatively were weakly correlated with elevated white blood cells. Postoperative improvement in MCS (ρ=0.306) and MCS recovery ratio (ρ=0.321) exhibited a weakly positive correlation with IL-6. Preoperative cytokine levels demonstrated minimal correlation with preoperative symptoms or clinical improvement, suggesting that profiling of patient cytokines has limited utility in predicting outcomes after ACDF. Level III.

How Do Patients With Predominant Neck Pain Improve After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy?

The presence of predominant pain in the arm vs the neck as a predictor of postoperative outcomes after anterior cervical discectomy and fusion (ACDF) has been seldom reported; therefore, the purpose of this study was to determine whether patients with predominant neck pain improve after surgery compared to patients with predominant arm pain or those with mixed symptoms in patients undergoing ACDF for radiculopathy. A retrospective cohort study was conducted on patients who underwent ACDF at a single center from 2016 to 2018. Patients were split into groups based on preoperative neck and arm pain scores: neck (N) pain dominant group (visual analog scale [VAS] neck ≥ VAS arm by 1.0 point); neutral group (VAS neck < VAS arm by 1.0 point); or arm (A) pain dominant group (VAS arm ≥ VAS neck by 1.0 point), using a threshold difference of 1.0 point. Subsequently, individuals were substratified into 2 groups based on the arm to neck pain ratio (ANR): non-arm pain dominant defined as ANR ≤1.0 and arm pain dominant (APD) defined as ANR >1.0. Patient-reported outcome measurements including Neck Disability Index (NDI), Physical Component Score-12, and Mental Component Score (MCS-12) were compared between groups. No significant differences between groups when stratifying patients using a threshold difference of 1.0 point. When stratifying patients using the ANR, those in the APD group had significantly higher postoperative MCS-12 (P = 0.008) and NDI (P = 0.011) scores. In addition, the APD group showed a greater magnitude of improvement for MCS-12 and NDI scores (P = 0.043 and P = 0.038, respectively). Multiple linear regression showed that the A and the APD groups were both independent predictors of improvement in NDI. Patients with dominant arm pain showed significantly greater improvement in terms of MCS-12 and NDI scores compared to patients with dominant neck pain. To compare the impact of ACDF on arm and neck pain in the context of cervical radiculopathy using patient-reported outcome measures as an objective measurement.

Full endoscopic anterior cervical discectomy and interbody fusion in patients with cervical spondylotic myelopathy

Background: For the surgical treatment of cervical spondylotic myelopathy (CSM), anterior decompression with fusion or posterior decompression using microscopy has been used widely as the standard procedure, depending on the location of pathology and the surgeon's preference. Endoscopic anterior cervical discectomy and interbody fusion (E-ACDF) is a minimally invasive, effective surgical option for the management of CSM. The advantages of using endoscopy for anterior cervical discectomy and interbody fusion (ACDF) are better visualization of the operative field with the possibility of changing the angle of the endoscope. This reduces the damage to the normal anatomical structure. Although long-term follow-up results are needed to evaluate fusion rate and complication, this appears to be a safe and feasible alternative to conventional ACDF for CSM. In this article, we have described the surgical technique, summarized the endoscopic process to discuss its operative strategies, and reviewed the radiographic records, pre- and postoperatively.Material and Methods: This retrospective review study included 36 cases aged 37 to 65 years, with CSM at one segment. All of them underwent full E-ACDF from January 2018 to April 2021. All patients were followed up for 12 months after the procedure by outpatient interviews. The clinical outcomes were evaluated based on the Visual Analog Scale (VAS) of the arm, and Japanese Orthopedic Association (JOA) score with clinical data at preoperative, 3, and 12 months after the operation. Hirabayashi method was used to assess the neurological recovery after 12 months of operation. Radiological outcomes were evaluated using plain radiography and magnetic resonance imaging, computed tomography scan to evaluate disc height, cervical lordosis (Cobb's angle), and solid fusion.Results: The mean operation time was 150 min (range 120–170 min) and the average length of hospital stay was 2 ± 3 days. There was one case of immediate postoperative anterior neck hematoma, which required open revision surgery. There was no case of infection or damage to the anterior visceral organ. The mean VAS scores for arm pain and mean JOA scores after endoscopic ACDF were significantly improved compared with before the operation during the follow-up period. The recovery rate, which was evaluated by the Hirabayashi method, looked good enough to indicate well recovered postoperatively. The disc height changed from 5.2 mm preoperatively to 6.2 mm after immediate postoperative and 5.9 mm after 6 months (P < 0.01). Cervical lordosis as Cobb's angle between C2 and C7 was significantly improved compared to the preoperative one during the follow-up periods also. The bone fusion rate was 100% at 6 months after the operation, and there was no segmental instability.Conclusions: The present study demonstrates that E-ACDF is a minimally invasive and effective surgical option for the surgical management of CSM. Based on the present study, E-ACDF may potentially enable the avoidance of various shortcomings related to surgical approaches. Through a sort of preliminary investigation, the authors confirmed the feasibility of E-ACDF and presented comparable outcome results, which might dispel the safety concern because of only one complication of wound hematoma. Better-designed randomized controlled studies with larger sample sizes in longer-term follow-ups are strongly warranted.

Clinical outcome measures and their evidence base in degenerative cervical myelopathy: a systematic review to inform a core measurement set (AO Spine RECODE-DCM)

ObjectivesTo evaluate the measurement properties of outcome measures currently used in the assessment of degenerative cervical myelopathy (DCM) for clinical research.DesignSystematic reviewData sourcesMEDLINE and EMBASE were searched through 4 August...

Dysphagia Weakly Correlates With Other Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion.

IntroductionDysphagia is a common complication after anterior cervical discectomy and fusion (ACDF), but it is not a routinely asked question in legacy patient-reported outcome measures (PROMs). This study analyzes whether there are associations between dysphagia and legacy outcome measures.MethodsWe retrospectively reviewed 168 patients who underwent ACDF surgery from 2017 to 2019 at a single institution. Demographics, anthropometric data, Neck Disability Index (NDI), Visual Analog Scale (VAS)-Arm and VAS-Neck Pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS)-Physical and PROMIS-Mental scores, Charlson Comorbidity Index (CCI), and Eating Assessment Tool-10 (EAT-10) were obtained for each patient preoperatively and at one, three, six, and 12 months postoperatively. Pearson’s correlation coefficients were used to evaluate the bivariate correlations between legacy, PROMIS, and EAT-10 measures.ResultsSignificant but weak correlations existed between NDI and EAT-10 at one, three, and six months postoperatively (correlation coefficient (R) = 0.31, 0.42, and 0.34 at one, three, and six months, p < 0.001) and VAS-Neck Pain and EAT-10 scores at one, three, and six months postoperatively (R = 0.27, 0.30, and 0.28 at one, three, and six months, p ≤ 0.004). Both PROMIS-Physical and PROMIS-Mental scores showed significant but weak correlations with EAT-10 scores at three and six months postoperatively (R = -0.29 and -0.25, p ≤ 0.01, at three months and R = -0.25 and -0.28, p < 0.01, at six months). In all comparisons of EAT-10 scores with legacy outcome measures, the significance of correlations disappeared by 12 months postoperatively. In addition, there was a positive association between CCI and EAT-10 score (β = 0.37, p < 0.05).ConclusionWeak correlations exist between self-reported dysphagia scores and legacy patient-reported outcome measures in patients undergoing ACDF. The correlation strength decreases over time; therefore, dysphagia scores should be reported separately when looking at outcomes after ACDF. Patients with more comorbidities are also at increased risk for dysphagia.

5. Impact of racial and ethnic disparities on health outcomes following cervical spine surgery

<h3>BACKGROUND CONTEXT</h3> Evidence suggests that Black non-Hispanic individuals are 39% to 44% more likely to have postoperative complications and prolonged length of stay after cervical spine surgery compared to White non-Hispanics. The long-term recovery of patient-reported health outcomes after cervical spine surgery among Hispanic and other non-Hispanic minorities (ie, Asian) remains unclear. Examining the postoperative recovery trajectory of Hispanic, Asian non-Hispanic, and Black non-Hispanic populations is important for identifying whether strategies are needed to reduce outcome disparities. <h3>PURPOSE</h3> The purpose of this study was to investigate the association of race and ethnicity with patient-reported health outcomes after cervical spine surgery. <h3>STUDY DESIGN/SETTING</h3> Retrospective analysis of data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD). <h3>PATIENT SAMPLE</h3> Data from 14,136 QOD participants (mean±SD; age=56.8±11.5 years; BMI=30.2±6.4 kg/m2 and 49% females) across 28 states in the Unites States who underwent elective surgery for degenerative cervical spine disease and completed 1-year follow-up were analyzed. Participants self-identified as Hispanic (n=343), non-Hispanic Black (n=1,191), Asian (n=112) or White (n=12,490). <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROs) were used for assessing disability (Neck Disability Index: NDI), neck and arm pain (11-point Numeric Rating Scale), and health-related quality of life (EuroQol EQ-5D) at the preoperative and 1-year time point after surgery. Minimal symptom state at 1-year was defined as achieving a score of ≤20 on NDI, and neck and arm pain scores ≤2. Satisfaction was assessed using a single item question at 1-year after surgery (NASS scale). <h3>METHODS</h3> Multivariable linear and logistic regression analyses were conducted to compute effect estimates 95% confidence interval (CI) to determine the association of racial/ethnic groups with PROs. Covariates included sociodemographic items (eg, age, sex, BMI, insurance, education, employment status), US census regions, surgical variables (eg, surgical approach, pathology), opioid use and preop PROs. Multiple imputation using predictive mean matching was used to impute missing demographic characteristics (<5% missing). <h3>RESULTS</h3> Of the 14,136 participants, 48% achieved minimal symptom state at 1-year. Black non-Hispanic had 57% (odds ratio [95%CI]: 1.57 [1.37, 1.81]) and Hispanics had 31% (1.31 [1.02, 1.69]) higher odds of not achieving minimal symptom state at 1-year follow-up compared to White non-Hispanic. Similar findings for Black or Hispanics vs White groups were observed for other PROs and satisfaction. There were no differences in any outcome measures between Asian and White. <h3>CONCLUSIONS</h3> Comparatively, White and Asian groups did not have increased likelihood, but Hispanics and Black groups did have increased likelihood of reporting poor outcomes following cervical spine surgery, even after adjusting for potential confounders. The findings of this study suggest the need to account for inherent racial and ethnic disparities to better understand the recovery trajectories following cervical spine surgery. Also, strategies to minimize racial and ethnic disparities are needed to ensure equitable access to postoperative care in this surgical population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

220. Do favorable short-term patient reported outcomes after spine surgery predict loss to one- and two-year follow-up?

<h3>BACKGROUND CONTEXT</h3> Because many spine surgery patients are lost to long-term postoperative follow-up, retrospective patient outcome studies are subjected to attritional bias. Controversy ensues in the literature on whether long-term follow-up is associated with adverse clinical outcomes. Furthermore, the factors associated with loss to follow-up after spine surgery are incompletely elucidated. <h3>PURPOSE</h3> To determine if spine surgery patients with greater improvement in patient reported outcomes measures (PROM) at early postoperative follow-up are more likely to be lost to follow-up at the one- year and two- year postoperative visits. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort analysis. <h3>PATIENT SAMPLE</h3> All patients over age 18 who underwent any primary or revision decompression or fusion surgery for degenerative spinal pathologies at a single academic institution were retrospectively identified. All included patients attended a short-term (3 month) postoperative follow-up visit. Patients with a traumatic injury, infection, malignancy, or incomplete medical records or outcome measures were excluded. <h3>OUTCOME MEASURES</h3> Postoperative short- and long- term PROMs: Neck Disability Index (NDI), Oswestry Disability Index (ODI), Short Form-12 (SF-12), VAS Neck, VAS Arm, VAS Back, VAS Leg, and PROMIS pain scores. Delta outcome score. Recovery ratio. <h3>METHODS</h3> Patient surgeries were stratified by anatomic region, revision status, and number of levels fused. Distance from patient residence to postoperative clinic site was determined. Patients lost to one- and two-year postoperative follow-up visits were identified. Univariate analysis compared patient demographics, surgical factors, distances traveled, and PROMs across groups with and without one- and two- year follow-up, respectively. Logistic regression isolated predictors of loss to follow-up. Multivariate regression compared PROMs based on long-term follow-up status. <h3>RESULTS</h3> A total of 1,412 patients met the inclusion criteria. In the total cohort, 25% of patients were lost to one- year follow-up and 66% were lost to two-year follow-up. Change in patient outcome measures and recovery ratios did not meaningfully differ between patient groups with and without one- and two-year follow-up on univariate nor multivariate analyses. Multiple patient factors were found to be associated with failure to follow up at one year after spine surgery including: decreased medical comorbidities, primary and single level surgeries, private insurance status, and longer distance from residence to clinic. Additionally, younger age and female sex were associated with failure to follow up two years after index surgery. <h3>CONCLUSIONS</h3> Patient outcomes were not found to impact loss to long-term follow-up after spine surgery. While a multitude of factors may predict patient propensity to follow-up, the lack of association between postoperative follow-up status and clinical outcome may limit bias introduced in retrospective PROM studies. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

251. Recovery kinetics and final outcomes for 1-2 level anterior cervical surgery is not impacted by anxiety and/or depression

<h3>BACKGROUND CONTEXT</h3> The postoperative recovery for anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) may be impacted by affective disorders, especially depression/anxiety. The authors hypothesized that depression/anxiety may slow recovery after anterior cervical surgery (ACDF or CDR) for cervical radiculopathy/myelopathy. <h3>PURPOSE</h3> To evaluate the effect of anxiety and depression on recovery speed after ACDF or CDR. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected data. <h3>PATIENT SAMPLE</h3> Patients who underwent 1-2 level ACDF or CDR for cervical radiculopathy/myelopathy and had at least 1-year follow-up and complete radiographic measurements and health related quality of life scores (HRQOLs) at 6 weeks, 3 months, 6 months and 1 year postoperatively. <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROMs) - 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 score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores were follow. <h3>METHODS</h3> Radiographic measurements of C2-C7 Cobb angle, cervical sagittal vertical axis (cSVA) and T1-slope were assessed preoperatively to ensure that the cohorts were similar in terms of alignment. Patients were stratified based on whether they had been diagnosed with anxiety/depression (A/D cohort) or not (non-A/D cohort). We compared recovery kinetics between the A/D versus non-A/D cohort. 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). We used a student's t-test to compare demographic information, radiographic parameters and HRQOLs between the A/D versus non-A/D cohort. <h3>RESULTS</h3> Forty-eight patients with a mean age of 50.0±11.8 years and comprising 22 females were included. All patients had minimum of 1-year follow-up. There were 10 patients in the A/D cohort. There were no significant differences in age (p = 0.18), baseline radiographic parameters (all p>0.10) or preop HRQOLs (all p>0.30) between the A/D versus non-A/D. After normalization there was no significant difference in terms of IHS for A/D versus non-A/D for NDI (0.66±0.38 vs 0.59±0.35, p=0.65), VAS-arm (0.55±0.40 vs 0.36±0.33, p=0.23), VAS-neck (0.55±0.28 vs 0.43±0.27, p=0.24), PROMIS (1.2±0.32 vs 1.3±0.37, p=0.48), SF-12 PCS (1.2±0.26 vs 1.2±0.28, p=0.79) or SF-12 MCS (1.1±0.17 vs 1.1±0.17, p=0.23). Final follow-up outcome scores were also similar for A/D vs non-A/D cohorts for all HRQOLs (all p>0.16). <h3>CONCLUSIONS</h3> We found no negative influence of anxiety/depression on either final-outcome scores or recovery kinetics after 1-2 level ACDF/CDR. Our analysis of IHS shows that the recovery speed after ACDF/CDR were not be impacted by a patient's comorbid anxiety/depression. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

P66. The impact of anxiety/depression on outcomes following 1-2 level anterior cervical surgery

<h3>BACKGROUND CONTEXT</h3> Outcomes after anterior cervical discectomy and fusion (ACDF) and cervical disc replacement (CDR) are likely impacted by the mental state of a patient during recovery. Psychologic factors such as anxiety/depression might negatively impact outcomes for a subset of patients. <h3>PURPOSE</h3> To elucidate whether anxiety/depression affect outcomes following 1-2 level anterior cervical surgery (ACDF or CDR) at short-term and final follow-up. <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected data. <h3>PATIENT SAMPLE</h3> Patients who underwent 1-2 level ACDF/CDR for cervical radiculopathy/myelopathy and had health related quality of life scores (HRQOLs) at 6 weeks, 3 months and 6 months out from surgery. <h3>OUTCOME MEASURES</h3> Patient-reported outcome measures (PROMs) - Neck disability index (NDI), short-form 12 physical component score (SF-12 PCS), short-form 12 mental component score (SF-12 MCS), PROMIS score, visual analog scale arm (VAS-arm) and neck (VAS-neck) pain scores. <h3>METHODS</h3> Duration of symptoms prior to surgery was recorded. HRQOLs, including NDI, SF-12 and VAS arm and neck were followed. Classic radiographic measurements of C2-C7 cob angle, cervical sagittal vertical axis (cSVA), and T1-Slope were assessed preoperatively to ensure that the cohorts were similar in terms of alignment. Patients were stratified whether they were diagnosed with anxiety/depression (A/D cohort) or not (non-A/D cohort). We compared outcome scores at each time point to determine if there was a difference in time to recovery for A/D patients.We tested normality of data using a Kolmogrov-Smirnov test. Student's t-test or Mann-Whitney test were used to compare normally and non-normally distributed HRQOLs respectively at each time point between the two cohorts. <h3>RESULTS</h3> There were 82 patients with at least 6-month follow-up (mean age 51.4±11.1 years old, 40 female). There were 16 patients in the A/D cohort. There were no significant differences in age (p=0.14), baseline radiographic parameters (all p>0.05), duration of symptoms (p=0.63) or preop HRQOLs (all p>0.77) between the A/D versus non-A/D. At 2 weeks, VAS-neck (p=0.04) and SF-12 MCS (p < 0.001) were worse for the A/D cohort. At 6 weeks, SF-12 MCS (p < 0.03) was less for the A/D cohort. At 3 months, SF-12 MCS (p<0.001) was worse for the A/D cohort. At final follow-up the only HRQOL that was statistically significant different between the cohorts was SF-12 MCS (54.5±8.4 vs 43.4±10.3, p<0.001) which was worse for the A/D cohort. <h3>CONCLUSIONS</h3> The impact of anxiety/depression on outcomes after 1-2 level ACDF/CDR is minimal. Specific HRQOL measures for mental health like SF-12 MCS will likely be lower in this population as we found within our dataset. Overall outcomes for patients with anxiety/depression mirror positive outcomes for those without these comorbid conditions after 1-2 level ACDF/CDR. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

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

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.