314 - Diminished Mental Health Prior to Cervical Fusion Can Have a Profound...

Oral Posters: Cervical

Presented by: J. Tishelman - View Audio/Video Presentation (Members Only)

Author(s):

B. Diebo(1), C. Jalai(2), J. Tishelman(2), G. Poorman(2), S. Horn(2), O. Bono(2), J. Moon(2), P. Passias(2)

(1) SUNY Downstate, Orthopaedic Surgery, Brooklyn, NY, United States
(2) NYU Hospital for Joint Diseases, Orthopaedic Surgery, New York, NY, United States

Abstract

Introduction: Optimizing outcomes is essential for effective surgical treatment of cervical spine disorders. For cervical spine pathologies, improvements in neck disability and physical functioning are important indicators of surgical success. Though mental impairment is commonly noted among patients with cervical spine complaints, comparative studies on baseline mental status and overall patient-reported improvement in specific diagnoses have not been proposed. This study analyzes patient reported outcomes over 2-years post-operative among cervical myelopathy and cervical radiculopathy diagnoses dependent on pre-operative mental status.

Materials and Methods: This was a retrospective analysis of a database of patients with cervical pathology prospectively collected from a multicenter spine registry. Inclusion criteria were patients diagnosed with either cervical spondylosis with myelopathy (´MYELO´) or radiculopathy (´RADIC´: cervical disc herniation, cervical stenosis, cervical spondylosis without myelopathy) and with complete follow-up through 2-years post-operative. Patients were assessed for the following health-related quality of life (HRQL) measures at baseline and 6-, 12-, and 24-months post-operative: Neck Disability Index (NDI), Short Form-36 (SF) Physical (PCS) and Mental (MCS) Component Summaries. Baseline MCS score for all included patients were dichotomized using 60th (MCS-HI) vs. 40th percentiles (MCS-LO), and in each diagnoses MCS groups were propensity score matched for baseline NDI value. Independent and paired t-tests compared improvement in each patient diagnosis group for MCS-HI and MCS-LO cohorts.

Results: A total of 439 patients were included for analysis (mean age 53.9 ± 10.5 years; mean BMI 28.6 ± 5.6 kg/m2; 62.9% female). The mean baseline MCS score was 39.1 ± 14.2, and was dichotomized into lower-40th (MCS-LO ≤39.00; mean 26.7 ± 7.2) and upper-60th (MCS-HI ≥42.00; mean 51.5 ± 6.7) percentile groups based on the score distribution for the total cohort. For MYELO, propensity matching gave 34 patients in each MCS group. At baseline, MYELO patients in both MCS-HI and MCS-LO had statistically similar NDI and PCS scores (p>0.05). However at 2-year follow-up, MYELO MCS-LO had significantly worse NDI (17.8 vs. 8.7, p< 0.001), despite overall baseline-2-year improvement in NDI (p=0.003). Myelopathy patients in the MCS-HI group displayed significant overall improvement in both PCS and NDI by 2-years post-operative (p< 0.015). Following propensity matching for radiculopathy patients, N=52 were in each MCS group. At baseline and 2-year post-operative, RADIC MCS-HI and MCS-LO were statistically similar for both NDI PCS (p>0.05). However, both MCS-HI and MCS-LO radiculopathy patients demonstrated significant improvement in overall PCS and NDI scores with treatment (p< 0.015).

Conclusions: This study revealed that pre-operative mental status, gauged by the SF-36 Mental Component Score, may be a useful tool in identifying discrepancies in overall patient-reported outcomes depending on the specific cervical spine diagnosis. Additional screening and care should be implemented for patient with cervical myelopathy for optimization of functional outcomes and disability status following surgical intervention. Levels of Evidence: III