(I-545) Comparing patient outcomes after cervical spine surgery for myelopathy vs. combined myeloradiculopathy with 1- and 2-year follow-up: A Multi-Institutional Retrospective Study Using the QOD Registry
Neurosurgery Resident University of Michigan Ann Arbor, Michigan, United States
Introduction: Myelopathy in the cervical spine can present with diverse symptoms, many of which can be debilitating for patients. Patient outcomes are currently assessed primarily using patient-reported outcomes (PROs), and play a significant role in the economic impact of spine surgery.
Methods: The Quality Outcomes Database (QOD) was used to analyze demographic, clinical and surgical variables between patients presenting with degenerative myelopathy vs. myeloradiculopathy. We assessed outcomes across multiple domains, comparing scores at 1- and 2-years using the modified Japanese Orthopedic Association (mJOA), EuroQol Visual Analogue Scale (EQ-VAS), and Neck Disability Index (NDI) surveys.
Results: 889 patients were included in the study (510 myelopathy, 379 myeloradiculopathy). Myeloradiculopathy patients presented with significantly more weakness (47.5% vs. 12.4%, p< 0.001), arm pain (71.8% vs. 0.0%, p< 0.001), numbness (78.1% vs. 35.5%, p< 0.001) and neck pain (79.2% vs. 42.2%, p< 0.001). Surgical approach for myeloradiculopathy patients differed significantly (75.2% posterior/24.8% anterior approach vs. 60.0% posterior/40.0% anterior approach, p=0.001) as did use of foraminotomy (24.4% vs. 6.5%, p< 0.001) compared to myelopathy patients.
Overall, 83% of patients completed 2-year follow-up for NDI, 76% for EQ-VAS, and 68% for mJOA scores. Myelopathy patients demonstrated significant improvements: baseline mJOA to 1-year (11.9 ± 2.8 vs. 13.6 ± 2.8, p< 0.001; 13.9 ± 2.7 at 2-years, p< 0.001), baseline EQ-VAS to 1-year (60.3 ± 21.8 vs. 70.1 ± 19.9, p< 0.001; 69.5 ± 22.1 at 2-years, p< 0.001) and baseline NDI to 1-year (34.0 ± 20.65 vs. 18.6 ± 18.1, p< 0.001; 18.1 ± 17.3 at 2-years, p< 0.001). Myeloradiculopathy patients similarly demonstrated improvement: baseline mJOA to 1-year (12.3 ± 2.8 vs. 14.2 ± 2.5, p< 0.001; 14.2 ± 2.5 at 2-years, p< 0.001), baseline EQ-VAS to 1-year (58.9 ± 22.2 vs. 70.5 ±21.3, p< 0.001; 68.8 ± 23.8 at 2-years, p< 0.001) and baseline NDI to 1-year (41.3 ± 20.9 vs. 21.2 ± 20.6, p< 0.001; 21.0 ± 20.0 at 2-years, p< 0.001).
Conclusion : Myelopathy and myeloradiculopathy patients demonstrated similar improvements in all PROs at 1-year and 2-years. Myeloradiculopathy patients underwent more foraminotomy and posterior cervical surgery. Appropriate surgical intervention leads to sustained clinical improvement in both patient groups.
