Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database

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  • 1 Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado;
  • | 2 Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;
  • | 3 Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina;
  • | 4 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;
  • | 5 Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina;
  • | 6 Department of Neurological Surgery, University of Utah, Salt Lake City, Utah;
  • | 7 Atlantic Neurosurgical Specialists, Morristown, New Jersey;
  • | 8 Department of Neurological Surgery, University of California, San Francisco, California; and
  • | 9 Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
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OBJECTIVE

The impact of the type of pain presentation on outcomes of spine surgery remains elusive. The aim of this study was to assess the impact of predominant symptom location (predominant arm pain vs predominant neck pain vs equal neck and arm pain) on postoperative improvement in patient-reported outcomes.

METHODS

The Quality Outcomes Database cervical spine module was queried for patients undergoing 1- or 2-level anterior cervical discectomy and fusion (ACDF) for degenerative spine disease.

RESULTS

A total of 9277 patients were included in the final analysis. Of these patients, 18.4% presented with predominant arm pain, 32.3% presented with predominant neck pain, and 49.3% presented with equal neck and arm pain. Patients with predominant neck pain were found to have higher (worse) 12-month Neck Disability Index (NDI) scores (coefficient 0.24, 95% CI 0.15–0.33; p < 0.0001). The three groups did not differ significantly in odds of return to work and achieving minimal clinically important difference in NDI score at the 12-month follow-up.

CONCLUSIONS

Analysis from a national spine registry showed significantly lower odds of patient satisfaction and worse NDI score at 1 year after surgery for patients with predominant neck pain when compared with patients with predominant arm pain and those with equal neck and arm pain after 1- or 2-level ACDF. With regard to return to work, all three groups (arm pain, neck pain, and equal arm and neck pain) were found to be similar after multivariable analysis. The authors’ results suggest that predominant pain location, especially predominant neck pain, might be a significant determinant of improvement in functional outcomes and patient satisfaction after ACDF for degenerative spine disease. In addition to confirmation of the common experience that patients with predominant neck pain have worse outcomes, the authors’ findings provide potential targets for improvement in patient management for these specific populations.

ABBREVIATIONS

ACDF = anterior cervical discectomy and fusion; MCID = minimal clinically important difference; NASS = North American Spine Society; NDI = Neck Disability Index; QOD = Quality Outcomes Database; VAS = visual analog scale.

Supplementary Materials

    • Supplemental Figs. 1-4 (PDF 1,039 KB)

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Contributor Notes

Correspondence Mohamad Bydon: Mayo Clinic, Rochester, MN. bydon.mohamad@mayo.edu.

INCLUDE WHEN CITING Published online July 9, 2021; DOI: 10.3171/2020.12.SPINE202002.

Disclosures Dr. Devin: consultant for Stryker and direct stock ownership in Balanced Back. Dr. Shaffrey: consultant for Medtronic, NuVasive, and SI Bone; direct stock ownership in NuVasive and Zimmer Biomet; royalties from NuVasive; and patent holder with Medtronic and NuVasive. Dr. Bisson: consultant for MiRus and Stryker and direct stock ownership in MiRus. Dr. Mummaneni: consultant for DePuy Synthes, Globus, and Stryker; direct stock ownership in Spinicity/isd; royalties from DePuy Synthes, Thieme, and Springer; clinical or research support for the study described from NREF; and support of non–study-related clinical or research effort from AO Spine, ISSG, and NIH. Dr. Foley: consultant for Medtronic, direct stock ownership in Discgenics, DuraStat, Medtronic, NuVasive, Practical Navigation/Fusion Robotics, RevBio, SpineWave, Tissue Differentiation Intelligence, Triad Life Sciences, and True Digital Surgery; patient holder with Medtronic and NuVasive; royalties from Medtronic; and board of directors for Discgenics, DuraStat, Practical Navigation/Fusion Robotics, RevBio, Tissue Differentiation Intelligence, Triad Life Sciences, and True Digital Surgery.

  • 1

    Todd AG. Cervical spine: degenerative conditions. Curr Rev Musculoskelet Med. 2011;4(4):168174.

  • 2

    Korinth MC. Treatment of cervical degenerative disc disease – current status and trends. Zentralbl Neurochir. 2008;69(3):113124.

  • 3

    Abbed KM, Coumans J-VCE. Cervical radiculopathy: pathophysiology, presentation, and clinical evaluation. Neurosurgery. 2007;60(1 Supp1 1):S28S34.

    • Search Google Scholar
    • Export Citation
  • 4

    Yarbrough CK, Murphy RKJ, Ray WZ, Stewart TJ. The natural history and clinical presentation of cervical spondylotic myelopathy. Adv Orthop. 2012;2012:480643.

    • Search Google Scholar
    • Export Citation
  • 5

    Henderson CM, Hennessy RG, Shuey HM Jr, Shackelford EG. Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. 1983;13(5):504512.

    • Search Google Scholar
    • Export Citation
  • 6

    Daffner SD, Hilibrand AS, Hanscom BS, et al. . Impact of neck and arm pain on overall health status. Spine (Phila Pa 1976).2003;28(17):20302035.

    • Search Google Scholar
    • Export Citation
  • 7

    Harrell FE Jr. Regression Modeling Strategies: With Applications to Linear Models, Logistic and Ordinal Regression, and Survival Analysis. Springer;2015.

    • Search Google Scholar
    • Export Citation
  • 8

    Harrell FE Jr. Regression modeling strategies. R package version 4.4-2. Accessed February 1, 2021. https://cran.r-project.org/web/packages/rms/index.html

    • Search Google Scholar
    • Export Citation
  • 9

    R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2012.Accessed February 1, 2021.https://www.r-project.org

    • Search Google Scholar
    • Export Citation
  • 10

    Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am. 1993;75(9):12981307.

    • Search Google Scholar
    • Export Citation
  • 11

    Gore DR, Sepic SB. Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine (Phila Pa 1976).1984;9(7):667671.

    • Search Google Scholar
    • Export Citation
  • 12

    Palit M, Schofferman J, Goldthwaite N, et al. . Anterior discectomy and fusion for the management of neck pain. Spine (Phila Pa 1976).1999;24(21):22242228.

    • Search Google Scholar
    • Export Citation
  • 13

    Passias PG, Hasan S, Radcliff K, et al. . Arm pain versus neck pain: a novel ratio as a predictor of post-operative clinical outcomes in cervical radiculopathy patients. Int J Spine Surg. 2018;12(5):629637.

    • Search Google Scholar
    • Export Citation
  • 14

    Chotai S, Sivaganesan A, Parker SL, et al. . Patient-specific factors associated with dissatisfaction after elective surgery for degenerative spine diseases. Neurosurgery. 2015;77(2):157163.

    • Search Google Scholar
    • Export Citation
  • 15

    Asher AL, Devin CJ, Kerezoudis P, et al. . Predictors of patient satisfaction following 1- or 2-level anterior cervical discectomy and fusion: insights from the Quality Outcomes Database. J Neurosurg Spine. 2019;31(6):835843.

    • Search Google Scholar
    • Export Citation
  • 16

    Eck JC, Humphreys SC, Hodges SD, Levi P. A comparison of outcomes of anterior cervical discectomy and fusion in patients with and without radicular symptoms. J Surg Orthop Adv. 2006;15(1):2426.

    • Search Google Scholar
    • Export Citation
  • 17

    Faour M, Anderson JT, Haas AR, et al. . Return to work rates after single-level cervical fusion for degenerative disc disease compared with fusion for radiculopathy in a workers’ compensation setting. Spine (Phila Pa 1976).2016;41(14):11601166.

    • Search Google Scholar
    • Export Citation

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