General Session: Cervical-2
Presented by: P. Nunley - View Audio/Video Presentation (Members Only)
P. Nunley(1), E. Kerr(1), D. Cavanaugh(1), A. Utter(1), K. Frank(1), M. Stone(1)
(1) Spine Institute of Louisiana, Shreveport, LA, United States
Purpose: Patient assessments such as the SF-12 generic health questionnaire and Visual Analog Scale are frequently used to preoperatively determine overall physical health and pain experienced by patients. Multiple studies have hypothesized that preoperative physical health and the degree of perceived pain can affect clinical outcomes following surgery. Some suggest that poor health and extreme pain may prevent patients from experiencing successful treatment. Here we analyze whether preoperative physical health and neck pain scores are predictive of patient outcomes following cervical spine surgery.
Methods: Data from an FDA IDE, multicenter, clinical trial of 245 patients comparing CDA to ACDF. CDA and ACDF patient data were similar preoperatively and at 60 months, so patient data were pooled. SF-12 PCS (PCS) and VAS neck analyses (VAS) were performed separately. Patients were first stratified into quartiles by preoperative PCS, classified as worst (18.78< PCS< 29.11), bad (29.11.≤PCS< 32.25), good (32.25≤PCS< 36.04) and best (36.04≤PCS< 56.58). For the second analysis, preoperative VAS neck (VAS) was classified into quartiles as worst (86.0≤VAS< 100), bad (77.0≤VAS< 86.0), good (63.0≤VAS< 77.0), and best (0< VAS< 63.0). Patient demographics, treatment received, NDI, VAS neck/arm pain, SF-12 MCS/PCS scores, overall success and secondary surgery rates were analyzed for difference across groups. ANOVA and Chi-square tests were used to compare 60 month scores across quartiles.
Results: When separated into preoperative PCS quartiles, there were no statistical differences found between gender, age or work status. Patients in the preoperative PCS quartiles demonstrated similar mean NDI, VAS neck, and SF-12 PCS scores at 60 months. Overall success and secondary surgery rates for PCS quartiles were also statistically similar although the worst group had a secondary surgery rate of 10.4% versus the best group at 3.5%. Preoperative VAS quartiles had statistical differences in gender and work status at baseline. Patients in the VAS quartile groups reported significantly different NDI (p< 0.05), PCS (p< 0.01) and VAS arm (p< 0.01) scores at 60 months. Although the mean scores were different at 60 months, percentage of improvement did not differ significantly between any of the groups. Secondary surgery rates were not significantly different for patients with the worst preoperative VAS, 10.7% versus 4.2% for the best group at 60 months. Preoperative VAS quartile outcomes in Figure 1.
Conclusion: Patients separated preoperatively by severity of PCS perform similarly at 60 months in all outcome measures. Higher preoperative VAS neck scores were indicative of worse NDI, VAS arm and PCS at 60 months. VAS and PCS worst groups had higher secondary surgery rates, although not statistically significant. The lack of statistically differences in PCS groups could indicate it is not a good preoperative predictor of patient success at 60 months. However, further investigation VAS neck pain may allow clinicians to better predict performance following cervical spine surgery.