Does Baseline Severity of Arm Pain Influence Outcomes Following Single-Level Anterior Cervical Discectomy and Fusion?

Patel Madhav Rajesh; Jacob Kevin Chacko; Chavez Frank A.; Parsons Alexander W.; Vanjani Nisheka Navin; Pawlowski Hanna; Prabhu Michael Clifford; Singh Kern

doi:10.31616/asj.2022.0027

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저자정보: Patel Madhav Rajesh (Department of Orthopaedic Surgery Rush University Medical Center Chicago IL USA) Jacob Kevin Chacko (Department of Orthopaedic Surgery Rush University Medical Center Chicago IL USA) Chavez Frank A. (Department of Orthopaedic Surgery Rush University Medical Center Chicago IL USA) Parsons Alexander W. (Department of Orthopaedic Surgery Rush University Medical Center Chicago IL USA) Vanjani Nisheka Navin (Department of Orthopaedic Surgery Rush University Medical Center Chicago IL USA) Pawlowski Hanna (Department of Orthopaedic Surgery Rush University Medical Center Chicago IL USA) Prabhu Michael Clifford (Department of Orthopaedic Surgery Rush University Medical Center Chicago IL USA) Singh Kern (Orthopaedic Surgery Rush University Medical Center Chicago IL USA)

저널정보: 대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.17 No.3

발행연도: 2023.6

수록면: 500 - 510 (11page)

DOI: 10.31616/asj.2022.0027

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Study Design: Retrospective cohort.Purpose: To assess preoperative arm pain severity influence on postoperative patient-reported outcomes measures (PROMs) and minimal clinically important difference (MCID) achievement following single-level anterior cervical discectomy and fusion (ACDF).Overview of Literature: There is evidence that preoperative symptom severity can affect postoperative outcomes. Few have evaluated this association between preoperative arm pain severity and postoperative PROMs and MCID achievement following ACDF.Methods: Individuals undergoing single-level ACDF were identified. Patients were grouped by preoperative Visual Analog Scale (VAS) arm ≤8 vs. >8. PROMs collected preoperatively and postoperatively included VAS-arm/VAS-neck/Neck Disability Index (NDI)/12-item Short Form (SF-12) Physical Composite Score (PCS)/SF-12 mental composite score (MCS)/Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF). Demographics, PROMs, and MCID rates were compared between cohorts.Results: A total of 128 patients were included. The VAS arm ≤8 cohort significantly improved for all PROMs excepting VAS arm at 1-year/2-years, SF-12 MCS at 12-weeks/1-year/2-years, and SF-12 PCS/PROMIS-PF at 6-weeks, only (p ≤0.021, all). The VAS arm >8 cohort significantly improved for VAS neck at all timepoints, VAS arm from 6-weeks to 1-year, NDI from 6-weeks to 6-months, and SF-12 MCS/PROMIS-PF at 6-months (p ≤0.038, all). Postoperatively, the VAS arm >8 cohort had higher VAS-neck (6 weeks/6 months), VAS-arm (12 weeks/6 months), NDI (6 weeks/6 months), lower SF-12 MCS (6 weeks/6 months), SF-12 PCS (6 months), and PROMISPF (12 weeks/6 months) (p ≤0.038, all). MCID achievement rates were higher among the VAS arm >8 cohort for the VAS-arm at 6-weeks/12-weeks/1-year/overall and NDI at 2 years (p ≤0.038, all).Conclusions: Significance in PROM score differences between VAS arm ≤8 vs. >8 generally dissipated at the 1-year and 2-year timepoint, although higher preoperative arm pain patients suffered from worse pain, disability, and mental/physical function scores. Furthermore, clinically meaningful rates of improvement were similar throughout the vast majority of timepoints for all PROMs studied.

#Patient reported outcome measures #Minimal clinically important difference #Visual Analog Scale arm #Anterior cervical discectomy and fusion

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