Search

To compare patients undergoing anterior cervical discectomy and fusion (ACDF) versus cervical disc replacement (CDR) for time to minimum clinically important difference (MCID) achievement and predictors of delayed MCID achievement for the patient-reported outcomes (PROs), Patient-Reported Outcomes Measurement Information System Physical Function, Neck Disability Index, Visual Analog Scale (VAS) neck, and VAS arm. PROs of patients undergoing ACDF or CDR were collected preoperatively and postoperatively at 6-week/12-week/6-month/1-year/2-year periods. MCID achievement was calculated through comparison of changes in Patient-Reported Outcomes Measurement to previously established values in literature. Time to MCID achievement and predictors for delayed MCID achievement were determined through Kaplan-Meier survival analysis and multivariable Cox regression, respectively. One hundred ninety-seven patients were identified, with 118 and 79 undergoing ACDF and CDR, respectively. Kaplan-Meier survival analysis demonstrated faster time to achieve MCID for CDR patients in Patient-Reported Outcomes Measurement Information System Physical Function (P = 0.006). Early predictors of MCID achievement through Cox regression were CDR procedure, Asian ethnicity, elevated preoperative PROs of VAS neck and VAS arm (hazard ratio, 1.16–7.28). Workers' compensation was a late predictor of MCID achievement (hazard ratio, 0.15). Most patients achieved MCID in physical function, disability, and back pain outcomes within 2 years of surgery. Patients undergoing CDR achieved MCID faster in physical function. Early predictors of MCID achievement were CDR procedure, Asian ethnicity, and elevated preoperative PROs of pain outcomes. Workers' compensation was a late predictor. These findings may be helpful in managing patient expectations. [ABSTRACT FROM AUTHOR]

Few studies have examined the influence of preoperative disability through the Oswestry Disability Index (ODI) on clinical outcomes in patients undergoing anterior lumbar interbody fusion (ALIF). Patients undergoing ALIF were separated into 2 groups based on ODI<41 (lower disability) versus ODI≥41% (higher disability). Patient-reported outcomes (PROs) were collected at preoperative and postoperative 6-week/12-week/6-month/1-year/2-year time points. Physical function PROs were Patient-Reported Outcomes Measurement Information System Physical Function and 12-item Short Form Physical Component Score. Mental function PROs were 12-item Short Form Mental Component Score and Patient Health Questionnaire-9. Pain PROs were visual analog scale back and visual analog scale leg. ODI was the disability PRO. A total of 148 patients were identified, with 52 patients with lower disability. Higher disability patients demonstrated significant improvement in mental function (P ≤ 0.010, all). Lower disability patients demonstrated superior postoperative PROs in physical function, mental function, back pain, and disability outcomes (P ≤ 0.034, all). Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower for mental function and disability outcomes (P ≤ 0.041, all). Independent of preoperative disability, patients undergoing ALIF reported significant postoperative improvement in physical function, pain, and disability outcomes. Patients with lower preoperative disability continued to report superior PROs in mental function, back pain, and disability postoperatively. Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower in mental function and disability outcomes. Patients undergoing ALIF with higher preoperative disability may experience greater clinically meaningful improvement in mental function and disability. [ABSTRACT FROM AUTHOR]