560 - Clinical Outcome Following Revision Surgery for Patients with Cervical...

#560 Clinical Outcome Following Revision Surgery for Patients with Cervical Spondylotic Myelopathy

Value and Outcomes in Spine Surgery

Poster Presented by: K. Nicholson

Author(s):

K. Nicholson (1)
G. Daubs (1)
T. Fried (2)
S. Stake (2)
P. Millhouse (2)
G. Schroeder (2)
D.G. Anderson (2)
C. Kepler (2)
M. Kurd (2)
J. Rihn (2)
A. Vaccaro (2)
A. Hilibrand (2)
K. Radcliff (2)
B. Woods (2)

(1) Rothman Institute, Philadelphia, PA, United States
(2) Rothman Institute, Thomas Jefferson University, Philadelphia, PA, United States

Abstract

Introduction: Cervical spondylotic myelopathy is often treated surgically. Early surgical intervention has been shown to halt functional decline and improve quality of life in these patients. The success of revision surgery in this population is less well-defined. The purpose of this study was to evaluate patient reported outcome data collected at least 1 year following a revision procedure in a subset of patients previously treated surgically for cervical spondylotic myelopathy.

Methods: Consecutive series of patients surgically treated for CSM between May 2014-June 2015 who had at least one prior cervical surgery for myelopathy. Patient-reported functional outcomes were collected prior to surgical intervention (baseline) and at least one-year after treatment. Outcomes collected were SF12 (PCS & MCS), NDI, neck pain, arm pain, and modified JOA (mJOA) score. Paired t-tests compared outcome scores at baseline to those collected at follow-up. Results reported as mean±SD.

Results: Baseline outcomes were collected from 45 patients (mean age 57±10 years) with a mean difference between index and revision procedures of 6.7±8.4 years (n=30 known index dates). 23 patients were treated with an ACDF (1.7±0.9 levels fused), 11 patients were treated with a PCDF (3.5±2.0 levels fused), 8 patients were treated with a combined A/PCDF (1.7±1.2 anterior levels fused anterior, 5.0±1.5 posterior levels fused), and 3 patients were treated with a 2-level decompression.
At baseline, patients reported poor physical (PCS =32.7±7.5) and mental (MCS=41.0±11.5) health, moderate-to-severe disability (NDI=46±19.4), moderate myelopathy symptoms (mJOA=13.5±2.7), and profound neck (6.2±3.0) and arm (5.5±3.0) pain.
Follow-up outcomes were collected from 31 patients (445±116 days post-operatively). mJOA significantly improved (2.1±3.4 points; p=0.006); 48% of the patients improved by more than 2 points (MCID). There were also significant improvements in neck disability (NDI -12.9±17.9; p=0.001), neck pain (-1.8±3.2; p=0.006) and mental health (MCS 3.8±10.2; p=0.048). Like mJOA, under half report improvements that would be considered greater than MCID (38% NDI>15 points; 46% neck pain< -2 points; 45% MCS>5 points). Improvements in physical health (PCS 3.1±10.4) and arm pain (1.2±4.7) were not significant. Patients treated with an ACDF or PCDF reported similar baseline and follow-up outcomes (Table 1).

Conclusions: Functional outcome improvement is modest after revision surgery for CSM; fewer than half achieve substantial clinical benefit. PCS is a sensitive measure of clinically meaningful improvement after surgery for CSM; the trivial PCS improvement suggests quality of life is not improved in the current study. Revision surgery to stabilize pseudarthrosis, adjacent degeneration, or deformity may still provide benefit by slowing the natural history of these conditions. Identifying the indication for revision should be considered for future study. Patient expectations for revision surgery should be tempered by noting average physical health status remained well-below the age-adjusted mean.

Table 1