59 - Cervical Spondylotic Myelopathy and Driving Abilities: Prevalence and Long-Term Postoperative Outcomes: A QOD Study

Saturday, June 3, 2023

11:06 AM – 11:08 AM

Location: Salons 10-12

Co-Author(s)

NA

Nitin Agarwal, M.D.

University of Pittsburgh Medical Center, United States
GM

Giorgos D. Michalopoulos, MD

Minnesota, United States
MB

Mohamad Bydon, MD

Rochester, Minnesota, United States
EB

Erica F. Bisson, MD, MPH

Utah, United States
AC

Andrew K. Chan, MD

Assistant Professor of Neurological Surgery (in Orthopaedic Surgery)
Columbia University
New York, New York, United States
SS

Saman Shabani, MD
VL

Vijay Letchuman, M.D.

University of California, San Francisco, United States
SS

Sally Sammak, M.D.

Minnesota, United States
DL

Daniel Lu, M.D., Ph.D.

United States
MW

Michael Y. Wang, MD

Professor
University of Miami Department of Neurosurgery
Miami, Florida, United States

Presenting Author (Person doing the Podium Present(s)

RL

Raj S. Lavadi, M.B.B.S.

Washington University School of Medicine in St. Louis, United States

Co-Author(s)

RH

Regis W. Haid, Jr., n/a

Atlanta Brain and Spine Care
Atlanta, Georgia, United States
JK

John J. Knightly, MD

New Jersey, United States
BS

Brandon Sherrod

Utah, United States
OG

Oren N. Gottfried, M.D.

Author
Duke University Medical Center, United States
CS

Christopher I. Shaffrey, Sr., MD

Duke University Medical Center
Durham, North Carolina, United States
JG

Jacob Goldberg, M.D.

United States
MV

Michael S. Virk, MD, PhD

United States
IH

Ibrahim Hussain, M.D.

United States
Steven D. Glassman, MD

Medical Director
Norton Leatherman Spine Center
Louisville, Kentucky, United States
MS

Mark E. Shaffrey, MD

United States
PP

Paul Park, MD

United States
KF

Kevin T. Foley, MD

United States
BP

Brenton Pennicooke, MD, MS

Missouri, United States
DC

Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery and Spine Associates
Charlotte, North Carolina, United States
JS

Jonathan R. Slotkin, MD

United States
CU

Cheerag Upadhyaya, MD, MBA, MSc

Clinical Associate Professor
University of North Carolina Chapel Hill
Durham, North Carolina, United States
EP

Eric A. Potts, MD

United States
LT

Luis M. Tumialán, M.D.

Barrow Neurological Institute, United States
DC

Dean Chou, MD

Columbia University, United States
KF

Kai-Ming Fu, M.D., Ph.D.

Weil Cornell Medical Center, United States
AA

Anthony L. Asher, MD

Carolina Neurosurgery and Spine Associates, United States
PM

Praveen V. Mummaneni, MD, MBA

Professor
University of California San Francisco
san francisco, California, United States

Submitter(s)

NA

Nitin Agarwal, M.D.

University of Pittsburgh Medical Center, United States

Introduction: Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and subsequent reduction in an individual’s quality of life, however, limited investigation has gone into assessing the impact of surgery on postoperative driving capabilities.

Aims/

Objectives: This study aims to evaluate the prevalence of driving difficulty in patients with CSM, describe postoperative outcomes, and identify predictors of long-term improvement.

Methods: The CSM database of the Quality Outcomes Database was utilized. Driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire – an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to the symptoms. A multivariable logistic model was used to evaluate the predictors of improvement in patient-reported symptomatology.

Results: A total of 1,141 patients who underwent surgical management of CSM were included, of which 814 (71.3%) patients had baseline difficulty driving due to CSM (NDI driving score ≥ 1). Of the 658 patients with baseline impairment and available 24-months follow-up, 475 patients (72.2%) reported a postoperative improvement in their driving ability. In the multivariable analysis, patients who did not improve were more likely to have severe baseline CSM (mJOA score < 12; OR = 0.47; 95% CI 0.26-0.85), numbness at baseline (OR = 0.63; 95% CI 0.40-0.97), and higher baseline neck pain (OR = 0.89; 95% CI 0.82-0.98). Conversely, higher baseline arm pain (OR = 1.09; 95% CI 1.02-1.18) and higher baseline NDI driving score (OR = 20.5; 95% 1.66-2.45) were predictive of improvement 24 months after surgery. Patients with improved driving at 24 months noted higher postoperative satisfaction (p < 0.01) and were more likely to achieve minimal clinically important differences for quality-adjusted life years (p < 0.01).

Conclusions: Most patients with advanced CSM report difficulty driving at presentation. Surgical management of CSM can significantly improve patients’ driving abilities at 24 months and, hence, their quality of life.