Effect of Social Factors on Surgical Outcomes in Cervical Disc Disease

Anterior surgical treatment for cervical degenerative radiculopathy: a prediction model for non-success

PURPOSE

By using data from the Norwegian Registry for Spine Surgery, we wanted to develop and validate prediction models for non-success in patients operated with anterior surgical techniques for cervical degenerative radiculopathy (CDR).

METHODS

This is a multicentre longitudinal study of 2022 patients undergoing CDR surgery and followed for 12 months to find prognostic models for non-success in neck disability and arm pain using multivariable logistic regression analysis. Model performance was evaluated by area under the receiver operating characteristic curve (AUC) and a calibration test. Internal validation by bootstrapping re-sampling with 1000 repetitions was applied to correct for over-optimism. The clinical usefulness of the neck disability model was explored by developing a risk matrix for individual case examples.

RESULTS

Thirty-eight percent of patients experienced non-success in neck disability and 35% in arm pain. Loss to follow-up was 35% for both groups. Predictors for non-success in neck disability were high physical demands in work, low level of education, pending litigation, previous neck surgery, long duration of arm pain, medium-to-high baseline disability score and presence of anxiety/depression. AUC was 0.78 (95% CI, 0.75, 0.82). For the arm pain model, all predictors for non-success in neck disability, except for anxiety/depression, were found to be significant in addition to foreign mother tongue, smoking and medium-to-high baseline arm pain. AUC was 0.68 (95% CI, 0.64, 0.72).

CONCLUSION

The neck disability model showed high discriminative performance, whereas the arm pain model was shown to be acceptable. Based upon the models, individualized risk estimates can be made and applied in shared decision-making with patients referred for surgical assessment.

Psychological predictors of quality of life after anterior cervical discectomy and fusion for degenerative cervical spine disease

We aimed to identify independent psychological predictors of quality of life (QOL) and functional outcome after anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine disease. We prospectively included patients undergoing ACDF for degenerative cervical disc herniation and stenosis. Patients completed a structured psychological assessment including the Center for Epidemiological Studies Depression Scale (ADS-K), Post-Traumatic Stress Scale-10 (PTSS-10), State Trait Anxiety Inventory-State Anxiety and - Trait Anxiety (STAI-S and STAI-T) and Anxiety Sensitivity Index-3 (ASI-3) before surgery, after 3 and 12 months. Outcome measures included EuroQol-5D (EQ), Short Form-36 (SF-36) and Oswestry Disability Index (ODI) scores. Of 104 included patients who underwent ACDF between March 2013 and November 2017, 92 completed follow-up after 3 and 12 months. The mean Visual Analogue Scale (VAS) scores for neck pain (− 1.4; p < .001) and arm pain (− 1.8; p = .031) significantly decreased by 12 months. QOL scores significantly increased by 3 months (EQ: + 0.2; p < .001; SF-36 PCS: + 6.2; p < .001; SF-36 MCS: + 2.5; p = .044), a benefit which was retained at 12 months. Linear regression analyses identified statistically significant predictors in preoperative ASI-3, SF-36 MCS and STAI-S for postoperative QOL and ODI scores. There is a benefit for patients in terms of quality of life and function after undergoing surgery for degenerative cervical spine disease. With the ASI-3, SF-36 MCS and STAI-S there exist some predictors for postoperative QOL and ODI scores.

Patient Activation is Not Associated With Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

STUDY DESIGN

This was a retrospective study.

OBJECTIVE

To determine whether an association exists between preoperative patient activation, as measured by the 10-Item Patient Activation Measure (PAM-10), and postoperative outcomes following anterior cervical discectomy and fusion (ACDF).

SUMMARY OF BACKGROUND DATA

Patient motivation in maintaining positive health behaviors, a concept known as patient activation, has been established as an indicator for improvement in pain, disability, and physical function after surgery. However, no studies examine the effect of preoperative patient activation scores on outcomes following ACDF.

METHODS

A prospectively maintained database was retrospectively reviewed and included patients that had a primary, 1-3 level ACDF for degenerative pathology. Patients were categorized into 3 subgroups according to their preoperative PAM-10 scores as follows: "low PAM" (bottom quartile), "moderate PAM" (second and third quartile), and "high PAM" (top quartile). Demographics and perioperative characteristics were recorded. Patient-reported outcomes including Neck Disability Index, 12-Item Short-Form Physical Component Score (SF-12 PCS), and Visual Analogue Scale (VAS) neck and arm pain were collected preoperatively and at 6-week, 3-month, 6-month, and 12-month postoperative follow-up.

RESULTS

A total of 64 patients were included in this analysis. Patients were stratified by their PAM scores as follows: 25 had a low PAM score, 19 had a moderate PAM score, and 20 had a high PAM score. There was no difference in inpatient VAS pain scores or narcotic consumption. In addition, there was no difference in improvement in VAS neck pain, VAS arm pain, Neck Disability Index, and SF-12 PCS among subgroups at all postoperative follow-ups.

CONCLUSIONS

Although PAM has been associated with better postoperative recovery in lumbar spine patients and other orthopedic surgeries, our investigation suggests that preoperative PAM assessments are not an effective method to predict postoperative outcomes following an ACDF.