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BACKGROUND CONTEXT Neck disability index (NDI) is a reliable measure for disability in patients with cervical myeloradiculopathy. Few studies have examined the relationship between NDI and mental health outcomes following anterior cervical discectomy and fusion (ACDF). PURPOSE To determine the correlation between NDI and mental health outcome measures following ACDF. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 225 patients undergoing primary, single or multi-level ACDF procedures. OUTCOME MEASURES Demographic and perioperative characteristics, NDI, 12-Item Short Form Mental Component Summary (SF-12 MCS) and Patient Health Questionnaire-9 (PHQ-9) Methods A prospectively maintained surgical registry was retrospectively reviewed for consecutive elective ACDF procedures from December 2013 to December 2019. Inclusion criteria were patients undergoing elective, primary, single or multi-level ACDF. Procedures indicated for infectious, traumatic or malignant etiologies were excluded. Demographic characteristics such as age, gender, body mass index (BMI), ethnicity, smoking and diabetic status, and insurance type were collected preoperatively. Medical comorbidities and classifications were preoperatively collected as American Society of Anesthesiologists physical classification (ASA) and Charlson comorbidity index (CCI). Preoperative characteristics including spinal pathology, operative time, blood loss, length of postoperative stay and day of discharge were also collected. Primary outcomes of interest were NDI and mental health outcome measures, SF-12 MCS and PHQ-9. Outcomes were collected at the preoperative timepoint as well as postoperative timepoints (6-weeks, 12-weeks, 6-months, 1-year, 2-years). Postoperative improvement for all outcomes was evaluated using a paired Student's t-test. Correlations between NDI and mental health outcomes were evaluated using Pearson's correlation analysis. Strength of association was determined using the following criteria: weak (0.1 ≤ |r| Results A total of 225 patients were included in this study. Mean age was 49.8 years with majority being male (57.8%) and nonobese (60.0%). Majority of patients had a single level procedure (55.6%), a spinal pathology of recurrent herniated nucleus pulposus (79.1%) and had a mean procedure time of 56.1 minutes, length of stay of 13.9 hours, and were typically discharged by postoperative day 0. NDI demonstrated significant improvements through 2-years compared to preoperative baseline values (all p Conclusions NDI demonstrated significant and strong correlations with mental health outcome measures at all postoperative timepoints. NDI is an effective measure to assess neck disability from cervical myeloradiculopathy, but it may also capture the impact on mental health following ACDF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Patient-Reported Outcomes Measurement Information System (PROMIS) utilizes computer adaptive testing (CAT) to accurately and efficiently assess patient improvement. Previous studies have highlighted the benefits of PROMIS over traditional “legacy” patient reported outcome measures (PROMs). However, literature comparing completion rates of PROMIS to those of legacy PROMs is scarce. PURPOSE To compare completion rates for PROMIS physical function (PF) with rates of legacy PROM completion following cervical spine procedures. STUDY DESIGN/SETTING Retrospective Cohort. PATIENT SAMPLE A total of 302 patients who underwent cervical spine procedures were included. OUTCOME MEASURES Perioperative characteristics including operative duration (from skin incision to closure), estimated blood loss (EBL), and postoperative length of stay were reported. Legacy PROMs such as Visual Analogue Scale (VAS) neck, VAS arm, neck disability index (NDI), and 12-Item Short-Form physical component summary (SF-12 PCS), as well as PROMIS-PF were included. METHODS A retrospective review was conducted of a prospectively maintained registry for cervical spine procedures from May 2015 to June 2020. Patients were excluded for procedures that were revisions or indicated for trauma, infection or malignancy. Patient demographics, preoperative medical conditions and spinal pathologies were collected. Perioperative characteristics including operative duration (from skin incision to closure), estimated blood loss (EBL), and postoperative length of stay were reported. Legacy PROMs such as Visual Analogue Scale (VAS) neck, VAS arm, neck disability index (NDI), and 12-Item Short-Form physical component summary (SF-12 PCS), as well as PROMIS-PF were administered at preoperative and postoperative (6-week, 12-week, 6-month, 1-year, and 2-year) timepoints. Descriptive statistics were performed for all preoperative and perioperative characteristics. McNemar's test was used to compare completion rates for each legacy PROM and PROMIS-PF at each timepoint. The overall percentage of surveys patients completed from the preoperative timepoint to 2-years for PROMIS-PF was compared with that of each legacy PROM using a paired t-test. RESULTS A total of 302 patients who underwent cervical spine procedures were included. The study cohort had a mean age of 50.0 years, was majority male (63.3%), non-obese (BMI CONCLUSIONS A greater proportion of cervical spine patients completed legacy PROMs at preoperative and earlier postoperative measurements. However, this difference was resolved by 1-year postoperatively and reversed by 2-years. Overall, patients completed a smaller percentage of assigned PROMIS-PF surveys than legacy PROMs. Although overall completion rates were lower for PROMIS-PF, patients may be more likely to complete PROMIS than legacy PROMs at long-term follow-up. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Previous studies have compared outcomes of anterior cervical discectomy and fusion (ACDF) with stand-alone interbody cage versus interbody cage with an anterior cervical plate. However, the impact of cervical plating has not been explored in terms of achievement of a minimum clinically important difference (MCID). PURPOSE To compare the impact of cervical plating on achievement of MCID up to 2-years following ACDF. STUDY DESIGN/SETTING Retrospective Cohort. PATIENT SAMPLE A total of 197 patients undergoing primary, single-level ACDF procedures with 102 receiving anterior cervical plating with interbody cage and 95 receiving a stand-alone cage. OUTCOME MEASURES Patient demographic characteristics, preoperative spinal diagnoses, perioperative information, Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), the 12-Item Short Form physical component summary (SF-12 PCS), Visual Analogue Scale (VAS) neck and VAS arm and Neck Disability Index (NDI). METHODS A database was queried for primary, single-level ACDF procedures. Patients were grouped based on whether their procedure included application of an anterior, intervertebral plate. Patient demographic characteristics, preoperative spinal diagnoses, and perioperative information were recorded. PROMs including Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), the 12-Item Short Form physical component summary (SF-12 PCS), Visual Analogue Scale (VAS) neck and VAS arm, and Neck Disability Index (NDI) were administered at preoperative and postoperative timepoints. Demographics, preoperative spinal diagnoses, and perioperative characteristics were compared between plating groups using chi squared and t-tests for categorical and continuous variables, respectively. Improvement in PROM scores was calculated as the difference between preoperative scores and each postoperative score. Achievement of an MCID was assessed using the following previously established thresholds: PROMIS-PF 4.5, SF-12 PCS 8.1, VAS neck 2.6, VAS arm 4.1, NDI 8.5. Rates of MCID achievement were compared between groups using a chi squared test. RESULTS Of 197 patients, 102 received plating and 95 received no plating. The mean cohort age was 47.2 years, 58.8% were male, and 47.2% were obese. Plating status was significantly associated with Charlson Comorbidity Index (p=0.003) and insurance status (p=0.014). Operative length and estimated blood loss were significantly greater for the plating group (p CONCLUSIONS Patients improved significantly in terms of pain, disability and physical function, regardless of plating status, and with the exception of early neck pain and disability, these improvements were similar between groups. However, patients that underwent plating as part of their ACDF procedure achieved an MCID for neck pain and disability at lower rates. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Few studies have investigated how neck pain and disability improve differently among patients with symptoms of both myelopathy and radiculopathy. PURPOSE To determine how neck pain and disability improve following anterior cervical discectomy and fusion (ACDF) among patients with myeloradiculopathy. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE This study included 187 eligible patients undergoing primary, elective, single or multilevel ACDF. OUTCOME MEASURES Demographics, perioperative information, and patient-reported outcome measures (PROM) were collected. PROMs included visual analog scale (VAS) neck and arm, neck disability index (NDI), 12-Item Short Form physical composite score (SF-12 PCS), Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF), and Patient Health Questionnaire 9 (PHQ-9). METHODS A surgical database was reviewed for primary, elective, single or multilevel ACDF. Demographics, perioperative information, and patient-reported outcome measures (PROM) were collected. PROMs included visual analog scale (VAS) neck and arm, neck disability index (NDI), 12-Item Short Form physical composite score (SF-12 PCS), Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF), and Patient Health Questionnaire 9 (PHQ-9). PROMs were collected preoperatively and postoperatively. Patients were categorized according to preoperative symptom severity: High VAS arm (>7); High NDI (>55); High VAS arm and NDI; and moderate symptoms. Demographics and perioperative information for groups were tested for independence using chi-squared analysis or t-test. Impact of preoperative symptom severity on PROM scores and magnitude of change were assessed using linear regression. Achievement of a minimum clinically important difference (MCID) was calculated for all groups using established values. Impact of preoperative symptoms on MCID achievement was determined using logistic regression. Alpha value was adjusted for multiple testing using a Bonferroni correction. RESULTS Of 187 eligible patients, there were 14 with High NDI, 46 with High VAS arm, 29 with High NDI and VAS arm, and 98 with neither high VAS arm or NDI. Mean age was 50.2 years, average BMI was 29.4 and 61.0% were male. Insurance collected was the only significant demographic between groups (p=0.014). No significant differences in perioperative characteristics were demonstrated. Preoperative VAS neck, VAS arm, NDI, SF-12 PCS, PROMIS PF, and PHQ-9 significantly differed by group (all p CONCLUSIONS Patients with myeloradiculopathy demonstrated significant differences in PROM scores based on severity of preoperative symptoms. PROM improvement and MCID achievement for neck disability, neck pain, and arm pain were the only values that differed based on symptom severity. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT The Patient Health Questionnaire-9 (PHQ-9) is a common instrument for assessing depressive symptoms and has been validated in numerous patient populations. Cross-fitting or double machine learning (ML) is a method of variable selection that has gained increased attention for its potential to identify coefficients of interest. Among patients undergoing anterior cervical discectomy and fusion (ACDF), a better understanding of the factors associated with greater depressive symptoms may assist in identifying patients who could benefit the most from management of depressive symptoms prior to surgical intervention. PURPOSE In this study, we use ML to assess and identify the most significant risk factors associated with moderately severe depressive symptoms (PHQ-9≥15) among patients undergoing ACDF. STUDY DESIGN/SETTING Retrospective Cohort. PATIENT SAMPLE A total of 147 patients who underwent single or multilevel ACDF procedures. OUTCOME MEASURES Demographic and baseline characteristics, pain levels (Visual Analog Scale [VAS] arm and neck pain). METHODS We conducted a retrospective review of patients undergoing single or multilevel ACDF between 2016 and 2019. We excluded patients if they underwent surgery due to infection, metastasis or trauma. Demographic and baseline characteristics were recorded. We recorded degenerative spinal diagnoses and symptoms and postoperative complications. We assessed demographics, baseline characteristics, pain levels (Visual Analog Scale [VAS] arm and neck pain) and spine pathologies with a bivariate analysis to explore how much they elevated the risk of preoperative depression. We used a cross-fit partialling-out least absolute shrinkage and selection operator (LASSO) logistic regression to estimate odds ratios (OR), confidence intervals, and to adequately control for and select significant covariates contributing to increased levels of preoperative depression. RESULTS There were 147 patients who underwent single or multilevel ACDF procedures. The cohort was 59% female, 43% had an elevated body mass index (BMI) and 16% had a smoking history. Other comorbidities included hypertension (29.3%), diabetes (12.2%), arm pain (49.7%) and neck pain (48.3%). The rate of moderately severe baseline depressive symptoms (PHQ-9≥15) was 16.3%. The most common preoperative spinal pathologies and symptoms included myeloradiculopathy (90.5%), herniated nucleus pulposus (82.3%), weakness (8.8%) and radiculopathy (6.8%). The only postoperative complication was urinary retention (1.4%). Both urinary retention cases required brief catheter replacement and were resolved prior to discharge. On bivariate analysis, significant baseline characteristics associated with higher levels of preoperative depression (PHQ-9 ≥ 15) included: BMI ≥30 kg/m2 (OR = 2.2, p = 0.040), WC insurance (OR = 2.2, p = 0.035), VAS arm pain ≥7 (OR = 2.5, p = 0.032), and VAS neck pain ≥7 (OR = 4.1, p = 0.003). Our cross-fit partialing-out LASSO regression revealed VAS neck pain ≥7 (OR = 6.8, p = 0.002) and BMI ≥30 kg/m2 (OR = 3.0, p = 0.034) as potentially significant risk factors for preoperative depression severity. CONCLUSIONS Our study utilized DML to identify risk factors associated with elevated levels of preoperative depression among patients undergoing single or multilevel ACDFs. The most significant risk factors associated with moderately severe depression included increased neck pain and BMI. Further investigations are needed to identify potential ACDF outcomes and complications that are most associated with increased levels of preoperative depression influences. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT The 12-Item Veterans RAND physical composite score (VR-12 PCS) has been assessed for use at short-term and intermediate timepoints for lumbar fusion populations. However, it has not been validated at long-term timepoints and relevant minimum clinically important difference (MCID) values have not yet been established. PURPOSE This study assesses the long-term validity and establishes potential MCID values of VR-12 PCS in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 74 patients undergoing primary, elective, single-level MIS TLIF procedures with posterior instrumentation were included. OUTCOME MEASURES Demographic characteristics, perioperative characteristics, VR-12 PCS, 12-Item Short Form (SF-12) PCS, and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF). Methods A surgical database was retrospectively reviewed for primary, elective, single-level MIS TLIF procedures with posterior instrumentation. Patients were excluded if preoperative and 2-year postoperative VR-12 PCS survey data was unavailable or if procedures were indicated due to trauma, infection, or malignancy. VR-12 PCS, 12-Item Short Form (SF-12) PCS, and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) measures were recorded at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. Responsiveness of the VR-12 measure was assessed in 2 ways: mean postoperative scores were compared to preoperative baseline values and MCID values were calculated using distribution- and anchor-based methods and used to assess improvement in VR-12 at 2-years. Convergent validity was assessed by the correlation of VR-12 PCS scores with SF-12 PCS and PROMIS PF scores at each timepoint. Floor and ceiling effects were assessed based on the total range of VR-12 PCS scores at each timepoint. Results A total of 74 patients were included. VR-12 PCS demonstrated significant postoperative improvements at all timepoints from 12-weeks to 2-years. Distribution-based MCID was calculated as 3.0 (⅓ SD) with an achievement rates of 73.0%. Anchor-based MCIDs were calculated as 7.8, 8.7 (cross-sectional) (p=.049 and p= Conclusions VR-12 PCS demonstrated good responsiveness, excellent convergent validity, and no significant floor or ceiling effects up to 2-years following MIS TLIF. Therefore, we recommend VR-12 PCS as a valid measure of long-term physical function in patients undergoing MIS TLIF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Few studies have investigated worsening of depressive symptoms following cervical spine procedures such as anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA). PURPOSE To evaluate risk factors associated with worsening depressive symptoms following ACDF or CDA. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 362 patients undergoing primary, elective, single or multilevel ACDF or CDA procedures. OUTCOME MEASURES Demographics, perioperative information, Short Form 12-Item and Veterans RAND Mental Component Summary (SF-12 and VR-12 MCS), Patient Health Questionnaire-9 (PHQ-9), visual analog scale (VAS) for neck and arm, and Neck Disability Index (NDI). METHODS A surgical registry was retrospectively reviewed for primary, elective, single or multilevel ACDF or CDA procedures. Demographics and perioperative information were collected and descriptive statistics performed. SF-12 and VR-12 MCS, PHQ-9, VAS for neck and arm, and NDI were collected preoperatively and at 6-weeks, 12-weeks, 6-months, and 1-year postoperatively. Improvement of all outcome measures from preoperative values was evaluated using paired student's t-test. Achievement of minimum clinically important difference (MCID) was evaluated by comparing the difference in preoperative and postoperative scores with the following preestablished values: 4.7 (SF-12 MCS), 8.1 (VR-12 MCS), and 3.0 (PHQ-9). Worsening of depressive symptoms, MCID “drop-off”, was defined as patients who demonstrated achievement of an MCID at an earlier postoperative timepoint and subsequently failed to achieve an MCID at a later timepoint. Bivariate poisson regression with robust error variance was performed to determine relative risk of demographic and perioperative characteristics with mental health MCID “drop-off”. RESULTS Of the eligible 362 patients, mean age was 49.0 years and 58.6% were male with a mean body mass index of 29.1 kg/m2 . Preoperatively 47.2% of patients had a high level of neck pain, 43.2% with high arm pain, 12.9% with a poor PHQ-9 score and 43.9% with a poor SF-12 MCS score. Majority of patients experienced myeloradicular symptoms (81.2%) and had a spinal pathology of herniated nucleus pulposus (85.4%). Majority of procedures were performed at the single level (61.4%) with 80.4% of procedures being ACDF and 19.6% being CDA. Mean operative time was 61.9 minutes with an average estimated blood loss of 40.3mL. The study cohort had a mean length of stay of 18.7 hours. Both SF-12 MCS and PHQ-9 demonstrated significant improvements from preoperative levels at all postoperative timepoints (all p CONCLUSIONS Cervical spine patients demonstrated significant improvements in mental health, pain, disability, and physical function following cervical procedures. Worse preoperative depressive symptoms and workers’ compensation were risk factors for reemergence of postoperative depression. These results may indicate that patients presenting with worse depression may be more susceptible to loss of initial improvements in mental health outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Patients receiving workers’ compensation (WC) demonstrate a propensity for poorer postoperative outcomes. PURPOSE This study determined rates of minimum clinically important difference (MCID) achievement in patients receiving WC following transforaminal interbody lumbar fusion (TLIF). STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 121 patients, out of 634, undergoing primary, single level TLIF with 29 receiving WC and 92 that were non-WC. OUTCOME MEASURES Visual analog score (VAS) for back and leg, Oswestry Disability Index (ODI), 12-Item Short Form Physical Component Summary (SF-12 PCS), and Patient Reported Outcome Measurement Information System (PROMIS) METHODS A retrospective review of a prospective surgical registry for patients undergoing primary, single level TLIF from 2015 to 2020 was performed. Patient reported outcome measures (PROM) were collected pre- and postoperatively as VAS for back and leg, ODI, SF-12 PCS and PROMIS. Patients were separated into two groups based on insurance collected: WC or Non-WC. To account for differences in demographic characteristics between groups and types of procedures, a propensity score match was performed. Postoperative improvement was assessed for all PROMs using paired t-test and intergroup differences were determined by linear regression. Achievement of MCID was calculated by comparison of the difference in preoperative and postoperative PROM scores with established values and any intergroup differences assessed using Chi-squared analysis. RESULTS Following propensity score matching, a total of 121 patients, out of 634, were included with 29 receiving WC and 92 that were non-WC. Mean age was 53.5 years with majority being male (63.6%). Groups differed in spinal diagnosis of isthmic spondylolisthesis (p=0.044). Following propensity score matching groups differed only in age, gender, and ethnicity (all p CONCLUSIONS Workers’ compensation patients demonstrated poorer postoperative outcomes at majority of timepoints. Additionally, a significantly lower rate of MCID achievement for back pain, disability, and physical function was observed overall and at intermittent timepoints for WC patients. WC patients may require alternative preoperative counseling regarding expectations for improvement following TLIF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Depression has been associated with poorer outcomes following anterior cervical discectomy and fusion (ACDF). However, research examining the relationship between depression and patient reported outcome measures (PROMs) in revision ACDF procedures is limited. PURPOSE To assess the relationship of depressive symptoms with PROMs in patients undergoing either primary or revision ACDF procedures. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE 143 patients undergoing primary or revision, single- or multilevel ACDF procedures. OUTCOME MEASURES Demographic and perioperative characteristics, Patient Health Questionnaire-9 (PHQ-9), visual analog scale (VAS), Neck Disability Index (NDI). METHODS A prospective database was retrospectively reviewed for primary or revision, single- or multi-level ACDF procedures from 2016 to 2020. Patients lacking preoperative PHQ-9 surveys were excluded. Demographic and perioperative characteristics were recorded and analyzed using Fisher's exact test or t-test. Patient-reported outcome measures were collected preoperatively and postoperatively. Postoperative improvement from baseline scores (ΔPROM) was calculated at all postoperative timepoints. Differences in mean PROM and ΔPROM between groups and changes from baseline PROM scores within groups were assessed using student's t-test. Linear regression analyzed the impact of preoperative PHQ-9 on ΔPROM among primary and revision patients. RESULTS A total of 143 patients (121 primary and 22 revision) were included. Significant differences between groups were demonstrated at the preoperative timepoint for NDI (p=0.022). ΔPROM values did not significantly differ between groups. Regression analysis revealed significant relationships between preoperative PHQ-9 and ΔPHQ-9 at all timepoints, ΔVAS neck at 6-weeks and 6-months, ΔVAS arm at 6-months, and ΔNDI at 6-weeks and 6-months for the primary group (all p CONCLUSIONS Primary or revision ACDF procedures did not significantly differ in depressive symptoms through 1-year. Primary ACDF patients significantly improved in all PROMs through all timepoints, while revision patients had limited improvement in PROMs. Preoperative depression may have a stronger association on postoperative outcomes for primary procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Minimum clinically important difference (MCID) has been lauded as a more relevant assessment of postoperative outcomes. However, patient expectations have also gained attention as an indicator for patient satisfaction. PURPOSE To compare the impact of achieving an MCID or meeting preoperative expectations on patient satisfaction following cervical spine procedures. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Seventy-seven patients undergoing primary or revision, single- or multilevel cervical disc replacement or anterior cervical discectomy and fusion (ACDF). OUTCOME MEASURES Demographic and perioperative characteristics, visual analogue scale (VAS) neck and arm. METHODS A database was reviewed for patients undergoing primary or revision, single- or multilevel cervical disc replacement or ACDF. Demographic and perioperative characteristics were collected and descriptive statistics were performed. Patients’ expectations for postoperative neck and arm pain were assessed preoperatively on a scale from 1-10. Visual analogue scale (VAS) neck and arm pain was assessed at preoperative and postoperative (6-week, 12-weeks, 6-months, 1-year) timepoints. Patient satisfaction regarding their current level of neck and arm pain was recorded at each postoperative timepoint. “Meeting expectations” was defined as postoperative VAS arm and neck scores equaling preoperative expectation scores. Achievement of MCID was determined using the following previously established values: VAS neck ≥ 2.6, VAS arm ≥ 4.1. Linear regression was used to determine if meeting expectations or achieving MCID were predictors of postoperative satisfaction. Differences in effect sizes of expectations met and MCID achievement as predictors of satisfaction were directly compared. RESULTS Of 77 patients, the cohort had a mean age of 48.8 years, was 40.3% female and 44.0% obese. Myeloradiculopathy was the most common preoperative spinal diagnosis (88.3%) and a majority of patients underwent ACDF (57.1%). Most procedures took place at a single level, mean operative time was 58.0 minutes and mean blood loss was 28.6 mL. Mean preoperative VAS arm and neck were 4.6 and 3.4, respectively. Mean satisfaction ranged from 6.4-7.5 for arm pain and 6.6-7.5 for neck pain. A majority of patients met expectations for arm pain through 6-months and at 12-weeks and 1-year for neck pain. A majority of patients met MCID for VAS neck through 6-months, but at no timepoints for VAS arm. Meeting expectations for arm and neck pain was a significant predictor of satisfaction at all timepoints except 6-months (all p≤0.003). Achieving MCID significantly predicted postoperative satisfaction at 6-weeks and 12-weeks for arm pain (both p≤0.013) and at 12-weeks and 6-months for neck pain (both p≤0.044). Meeting expectations was a significantly stronger predictor of satisfaction than MCID for both arm and neck pain at 1-year (p=0.007, p=0.012). CONCLUSIONS Both MCID achievement and meeting expectations for VAS arm and neck were significant predictors of satisfaction at short-term timepoints. However, meeting expectations was the only significant predictor of satisfaction at 1-year. This suggests patient expectations may be a more valuable metric for assessing patient perceptions of long-term pain improvement following cervical spine procedures. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs

BACKGROUND CONTEXT Previous studies have examined factors that determine patient satisfaction following anterior cervical discectomy and fusion (ACDF). However, few have explored the influence of meeting preoperative expectations on postoperative satisfaction. PURPOSE To assess the predictive value of meeting preoperative expectations for patient satisfaction following ACDF. STUDY DESIGN/SETTING Retrospective Cohort. PATIENT SAMPLE A total of 34 patients undergoing primary ACDF procedures. OUTCOME MEASURES Demographic and perioperative characteristics, Visual Analog Scale (VAS) neck and arm. METHODS A prospectively maintained surgical registry was retrospectively reviewed for ACDF procedures from 2016 to 2019. Patients’ expectations regarding surgical outcomes in neck and arm pain were assessed preoperatively using the questions, “What do you expect your [arm/neck] pain to be following surgery?” Current levels of pain were assessed using the Visual Analogue Scale (VAS) at preoperative and 6-week, 12-week, 6-month and 1-year postoperative timepoints, while patients’ satisfaction with their current level of pain was assessed on a scale of 1-10 at each postoperative timepoint. Whether expectations were met was evaluated by comparison of expectation scores to actual postoperative VAS scores. Linear regression assessed pain improvement and meeting expectations as predictors of satisfaction scores at each timepoint. RESULTS The study cohort consisted of 34 patients undergoing primary ACDF procedures. By 1-year postoperatively, 85.3% and 82.4% of patients had met their expectations for neck and arm pain, respectively. Improvement in pain was a significant predictor of satisfaction only for neck pain at 6-months (p=0.001) and arm pain at 12-weeks (p=0.014) and 6-months (p=0.001). Meeting preoperative expectations was a significant predictor of satisfaction at all timepoints (all p CONCLUSIONS Most patients achieved their preoperative expectations for neck and arm pain by 1-year following ACDF. While overall improvement in pain only predicted postoperative satisfaction at a few timepoints, meeting preoperative expectations for postoperative pain significantly predicted patient satisfaction at all timepoints except 6-weeks. Therefore, patients’ preoperative expectations may actually be a more important indicator for postoperative success than their raw improvement in pain scores. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.