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Devin CJ, Asher AL, Alvi MA, et al. Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database. J Neurosurg Spine. 2021;35(4):399-409doi: 10.3171/2020.12.SPINE202002.
Devin, C. J., Asher, A. L., Alvi, M. A., Yolcu, Y. U., Kerezoudis, P., Shaffrey, C. I., Bisson, E. F., Knightly, J. J., Mummaneni, P. V., Foley, K. T., & Bydon, M. (2021). Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database. Journal of neurosurgery. Spine, 35(4), 399-409. https://doi.org/10.3171/2020.12.SPINE202002
Devin, Clinton J, et al. "Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database." Journal of neurosurgery. Spine vol. 35,4 (2021): 399-409. doi: https://doi.org/10.3171/2020.12.SPINE202002
Devin CJ, Asher AL, Alvi MA, Yolcu YU, Kerezoudis P, Shaffrey CI, Bisson EF, Knightly JJ, Mummaneni PV, Foley KT, Bydon M. Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database. J Neurosurg Spine. 2021 Jul 09;35(4):399-409. doi: 10.3171/2020.12.SPINE202002. PMID: 34243164.
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J Neurosurg Spine. 2021 Jul 09;35(4):399-409. doi: 10.3171/2020.12.SPINE202002.

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

Journal of neurosurgery. Spine

Clinton J Devin, Anthony L Asher, Mohammed Ali Alvi, Yagiz U Yolcu, Panagiotis Kerezoudis, Christopher I Shaffrey, Erica F Bisson, John J Knightly, Praveen V Mummaneni, Kevin T Foley, Mohamad Bydon

Affiliations

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

PMID: 34243164 DOI: 10.3171/2020.12.SPINE202002

Abstract

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.

Keywords: QOD; Quality Outcomes Database; arm pain; cervical spine; degenerative spine; neck pain; spine surgery

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