65 - Impact of Cervical Spondylotic Myelopathy on Preoperative and Postoperative Care Dependency: A Quality Outcomes Database (QOD) Study

Saturday, June 3, 2023

11:18 AM – 11:20 AM

Location: Salons 10-12

Presenting Author (Person doing the Podium Present(s)

NA

Nitin Agarwal, M.D.

University of Pittsburgh Medical Center, United States

Co-Author(s)

EB

Erica F. Bisson, MD, MPH

Utah, United States
MB

Mohamad Bydon, MD

Rochester, Minnesota, United States
AA

Anthony L. Asher, MD

Charlotte, North Carolina, United States
AC

Andrew K. Chan, MD

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

Michael Y. Wang, MD

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

Michael S. Virk, MD, PhD

United States
MS

Mark E. Shaffrey, MD

United States
PP

Paul Park, MD

United States
KF

Kevin T. Foley, MD

United States
DC

Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery and Spine Associates
Charlotte, North Carolina, 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
KF

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

Weil Cornell Medical Center, United States
RL

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

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

Sarah E. Johnson, MBBS

Research Fellow
Mayo Clinic
Rochester, Minnesota, United States
DC

Dean Chou, MD

Columbia University, United States
PM

Praveen V. Mummaneni, MD, MBA

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

Introduction: Chronic degenerative diseases have been associated with reduced quality of life and dependency on others for personal needs and care. The aspect of preoperative and postoperative care dependency has yet to be explored in patients with cervical spondylotic myelopathy (CSM).

Aims/

Objectives: To explore the aspect of preoperative and postoperative care dependency in patients with CSM.

Methods: The CSM dataset of the Quality Outcomes Database (QOD) was queried. Care dependency was assessed using the personal care component of the Neck Disability Index (NDI) questionnaire – an ordinal scale from 0 to 5; 5 being the inability to get dressed with activity restriction. Numeric rating scale (NRS) arm pain, neck pain, and EuroQol-5D (EQ-5D) in quality-adjusted life years (QALY) scores were recorded up to 24 months postoperatively. Multivariable logistic regression analyses were performed to identify baseline risk factors for the inability to care for oneself and the symptoms leading to care dependency at 24 months postoperatively.

Results: Of the 1,137 patients with CSM who underwent surgical management, 167 patients (14.7%) were care-dependent at baseline (NDI personal care score > 2). Patients with care dependency were predominantly Medicare beneficiaries, had a high school or lower level of education, with severe myelopathy at baseline. At 24-month follow-up, 112 (81.8%) patients who were dependent before surgery became independent in the ability to take care of themselves. Patients who experienced a resolution in their care dependency at 24 months had higher EQ-5D scores (p < 0.01). Neck pain, upper extremity dysfunction, lower extremity dysfunction, and bladder dysfunction were symptoms that were significantly associated with care dependency at 24 months postoperatively (p < 0.01).

Conclusion: Personal care impairment is a rare, yet burdensome, consequence of CSM. Surgical management of CSM helped to achieve independence in personal care. Patients who regained the ability to care for themselves postoperatively reported a better quality of life.