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- Title
Assessing Surgical Outcomes For Cervical Radiculopathy And Myelopathy: Comparing Ndi And Promis Pf Cat.
- Authors
Spina, Nicholas; Spiker, William Ryan; Lawrence, Brandon D.; Yue Zhang; Brodke, Darrel S.
- Abstract
Introduction: Patient reported outcomes (PROs) are critical in assessing the efficacy of surgical interventions. Recently, the Patient-Reported Outcomes Measurement Information System (PROMIS®) was developed which focuses on many domains of health, one of which is physical function (PROMIS PF). PROMIS PF is not disease specific like many legacy scores including the Neck Disability Index (NDI). It has been shown to have overall good coverage and reliability in patients with musculoskeletal complaints including those with spine pathology. (1, 2) Yet, the responsiveness of PROMIS PF to treatment of cervical spinal pathology has not been investigated. Therefore, the purpose of this study is to evaluate the responsiveness of PROMIS PF and NDI in patients undergoing anterior cervical discectomy and fusions (ACDF) for either myelopathy or radiculopathy. Materials and Methods: A retrospective, single center review was performed identifying patients undergoing a single or two level ACDF for myelopathy or radiculopathy between 2013-present with NDI and PROMIS PF for review. Patients with an additional diagnosis of trauma, tumor, or infection were excluded. PROs were recorded preoperatively and at 6 weeks, 3, 6, and 12 months post-operatively. A Linear Mixed Effect model was used to estimate and compare the adjusted means of both the NDI and PROMIS PF scores at time points between patients treated for myelopathy (MG) vs radiculopathy (RG). Age, gender and BMI were adjusted for in the outcome models. Likelihood ratio tests were employed to examine global differences in the trajectory of patient-reported outcomes. Statistical significance was set at a level of 0.05. Results: 171 patients were identified meeting inclusion criteria, 105 with myelopathy and 66 with radiculopathy. The average PROMIS PF score was significantly higher pre-operatively in the RG compared to the MG (39.6 vs 37.3 p = .006) as well as 1 year postoperatively (42.1 vs 38.1 p = .009). No statistical difference in NDI score was observed between groups at any time point. Both groups demonstrated a positive treatment response over the 12 month period. The mean treatment effect for RG, MG at 6 months was -21.3, -14.3 and at 12 months -15.4, -11.4 in NDI and 2.4, 4.3 at 6 and 2.5, 0.8 at 12 months for PROMIS PF. No significant difference was seen in treatment effect between groups in NDI and PROMIS PF at any time point. Conclusion: Myelopathy and radiculopathy have vastly different presentations. Yet, in our study, these patients were indistinguishable in terms of NDI. PROMIS PF was significantly higher in the RG, both pre- and post-operatively, which is more consistent with a radicular vs myelopathic disease state. The 1 year mean treatment effect, in terms of NDI, surpassed an NDI minimally clinical important difference (MCID) of 7.5. (3) The average treatment effect at 12 months in PROMIS PF was 0.8 MG and 2.5 RG. It is unclear as to the significance of these figures given a PROMIS PF MCID has not been reported. Further study is needed to determine whether PROMIS PF is responsive enough to detect meaningful changes in radicular symptoms given it is largely a test of overall functional mobility.
- Publication
Global Spine Journal, 2018, Vol 8, p237S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771072