144 - What Factors Predict the Best Outcomes for Disability, Quality of Life, and Functional Status Following Surgery for Cervical Spondylotic Myelopathy?

Friday, June 2, 2023

3:27 PM – 3:31 PM

Location: Salon 9

Co-Author(s)

AC

Andrew K. Chan, MD

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

Christopher I. Shaffrey, Sr., MD

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

Christine Park

Durham, North Carolina, United States
OG

Oren N. Gottfried, M.D.

Author
Duke University Medical Center, United States

Presenting Author (Person doing the Podium Present(s)

EB

Erica F. Bisson, MD, MPH

Utah, United States

Co-Author(s)

MB

Mohamad Bydon, MD

Rochester, Minnesota, United States
AA

Anthony L. Asher, MD

Carolina Neurosurgery and Spine Associates, United States
DC

Domagoj Coric, MD

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

Eric A. Potts, MD

United States
KF

Kevin T. Foley, MD

United States
MW

Michael Y. Wang, MD

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

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

Weil Cornell Medical Center, United States
MV

Michael S. Virk, MD, PhD

United States
JK

John Knightly, MD

ANS
Morristown, New Jersey, United States
SM

Scott Meyer

United States
PP

Paul Park, MD

United States
CU

Cheerag Upadhyaya, MD, MBA, MSc

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

Mark E. Shaffrey, MD

United States
AB

Avery L. Buchholz, MD

Neurosurgeon
Columbia, South Carolina, United States
LT

Luis M. Tumialán, M.D.

Barrow Neurological Institute, United States
JT

Jay D. Turner, M.D., Ph.D.

Neurosurgeon
Barrow Neurological Institute
Phoenix, Arizona, United States
GM

Giorgos D. Michalopoulos, MD

Minnesota, United States
BS

Brandon Sherrod

Utah, United States
NA

Nitin Agarwal, M.D.

University of Pittsburgh Medical Center, United States
DC

Dean Chou, MD

Columbia University, United States
RH

Regis W. Haid, Jr., n/a

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

Praveen V. Mummaneni, MD, MBA

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

Submitter(s)

AC

Andrew K. Chan, MD

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

Co-Author(s)

VL

Vivian P. Le, M.P.H.

Columbia University Irving Medical Center, United States

Introduction: The predictors of the best outcomes following surgery for cervical spondylotic myelopathy (CSM) are not clearly defined. We leveraged the largest prospective cohort of operative patients with CSM to help identify factors predicting the best outcomes following CSM surgery.

Aims/

Objectives: Various baseline characteristics will have significant associations with outcomes for disability, quality of life, and functional status after surgery for cervical spondylotic myelopathy (CSM).

Methods: Patients from the Quality Outcomes Database CSM module were included. Baseline characteristics were compared for those in the top and bottom 20th percentile 24-month (A) NDI change score, (B) EQ-5D change score, and (C) mJOA change score. A multivariable logistic model was constructed and included candidate variables reaching p< 0.20 on univariate analyses. Backward elimination, with assessment for interactions, was then used to determine significant predictors of the best outcomes (top 20th percentile) for 24-month NDI, EQ-5D, and mJOA change.

Results: Overall, 1,141 patients were prospectively enrolled. Factors predicting the best NDI outcomes included symptom duration less than 12 months (OR=1.4, 95%CI[1.1-1.9],p=0.01), procedure other than posterior laminectomy and fusion (OR=1.5, 95%CI[1.03-2.1],p=0.03), higher preoperative VAS neck pain score (OR=1.2, 95%CI[1.1-1.3],p < 0.001), and higher baseline disability (OR=1.06, 95%CI[1.05-1.07],p < 0.001). Factors predicting the best EQ-5D outcomes included arm-only pain complaints (compared to neck pain) (OR=1.9, 95%CI[1.3-2.9],p=0.002) and lower baseline EQ-5D (OR=167.7 per unit lower, 95%CI[85.0-339.4],p < 0.001). Factors predicting the best mJOA outcomes included lower BMI (OR=1.03 per unit lower, 95%CI[1.004-1.05],p=0.02), arm-pain only complaints preoperatively (compared to neck pain) (OR=1.7, 95%CI[1.1-2.5],p=0.02), and lower baseline mJOA (OR=1.6 per unit lower, 95%CI[1.5-1.7],p < 0.001).

Conclusion: For NDI, those with the best outcomes had shorter symptom durations, higher preoperative neck pain scores, and less often underwent posterior laminectomy and fusions. For EQ-5D, the best outcomes were associated with patients with arm-pain only complaints (with no neck pain). For mJOA, lower BMI and arm-pain only complaints portended the best outcomes. Those with the worst baseline PROs had the largest magnitudes of improvement.