PMID- 31809467
OWN - NLM
STAT- MEDLINE
DCOM- 20200922
LR  - 20210115
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Linking)
VI  - 45
IP  - 10
DP  - 2020 May 15
TI  - Severity of Preoperative Myelopathy Symptoms Affects Patient-reported Outcomes, 
      Satisfaction, and Return to Work After Anterior Cervical Discectomy and Fusion 
      for Degenerative Cervical Myelopathy.
PG  - 649-656
LID - 10.1097/BRS.0000000000003354 [doi]
AB  - STUDY DESIGN: Retrospective review of prospectively-collected registry data. 
      OBJECTIVE: To compare the patient-reported outcomes, satisfaction, and return to 
      work among a large cohort of patients stratified by preoperative myelopathy 
      severity undergoing Anterior Cervical Discectomy and Fusion (ACDF) for 
      Degenerative Cervical Myelopathy. SUMMARY OF BACKGROUND DATA: Recent clinical 
      practice guidelines noted a lack of studies stratifying their sample based on 
      preoperative disease severity. The benefits of early surgical intervention for 
      patients with mild myelopathy remain uncertain. METHODS: A 
      prospectively-maintained registry was retrospectively reviewed for all patients 
      who underwent primary ACDF for Degenerative Cervical Myelopathy. Patients were 
      stratified based on severity of preoperative myelopathy symptoms according to the 
      Japanese Orthopaedic Association (JOA) scale: mild (>13), moderate (9-13), or 
      severe (<9). Patients were prospectively followed for at least 2 years. RESULTS: 
      In total, 219 patients were included: 74 mild, 94 moderate, and 51 severe cases. 
      The mild group had significantly better Neurogenic Symptoms (NS), Neck Disability 
      Index (NDI), SF-36 Physical (PCS), and Mental Component Summary at baseline 
      (P < 0.05). Neck and arm pain scores were similar at all time points. At 2 years, 
      the severe group still had significantly worse patient-reported outcomes and 
      lower rates of satisfaction, expectation fulfilment and return to work. However, 
      they had significantly greater improvement in JOA, Neurogenic Symptoms, NDI, PCS, 
      and Mental Component Summary, and a larger proportion attained minimal clinically 
      important difference (MCID) for NDI and PCS. All three groups had similar 
      proportions attaining MCID for JOA. CONCLUSION: Patients with severe myelopathy 
      experienced a greater improvement after ACDF. Although fewer patients attained 
      MCID, early surgical intervention for patients with mild myelopathy should also 
      be considered, as this may allow patients to maintain their higher functional 
      status. They also had high rates of postoperative satisfaction and return to 
      work. The clinical trajectory outlined in this study may provide valuable 
      prognostic information for patients. LEVEL OF EVIDENCE: 3.
FAU - Goh, Graham Seow-Hng
AU  - Goh GS
AD  - Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
FAU - Liow, Ming Han Lincoln
AU  - Liow MHL
AD  - Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
FAU - Ling, Zhixing Marcus
AU  - Ling ZM
AD  - Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
FAU - Soh, Reuben Chee Cheong
AU  - Soh RCC
AD  - Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
FAU - Guo, Chang Ming
AU  - Guo CM
AD  - Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
FAU - Yue, Wai Mun
AU  - Yue WM
AD  - The Orthopaedic Centre, Mount Elizabeth Medical Centre, Singapore.
FAU - Tan, Seang Beng
AU  - Tan SB
AD  - Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, Singapore.
FAU - Chen, John Li-Tat
AU  - Chen JL
AD  - Department of Orthopedic Surgery, Singapore General Hospital, Singapore.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cervical Vertebrae/surgery
MH  - Diskectomy/*psychology/trends
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neck Pain/psychology/surgery
MH  - *Patient Satisfaction
MH  - Preoperative Care/*psychology/trends
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Return to Work/*psychology/trends
MH  - Severity of Illness Index
MH  - Spinal Cord Diseases/*psychology/surgery
MH  - Spinal Fusion/*psychology/trends
MH  - Treatment Outcome
EDAT- 2019/12/07 06:00
MHDA- 2020/09/23 06:00
CRDT- 2019/12/07 06:00
PHST- 2019/12/07 06:00 [pubmed]
PHST- 2020/09/23 06:00 [medline]
PHST- 2019/12/07 06:00 [entrez]
AID - 00007632-202005150-00005 [pii]
AID - 10.1097/BRS.0000000000003354 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2020 May 15;45(10):649-656. doi: 
      10.1097/BRS.0000000000003354.