PMID- 32349058
OWN - NLM
STAT- MEDLINE
DCOM- 20211025
LR  - 20211025
IS  - 2380-0194 (Electronic)
IS  - 2380-0186 (Linking)
VI  - 33
IP  - 10
DP  - 2020 Dec
TI  - Predictors of Outcomes After Single-level Anterior Cervical Discectomy and Fusion 
      for Cervical Spondylotic Myelopathy: A Multivariate Analysis.
PG  - E525-E532
LID - 10.1097/BSD.0000000000000997 [doi]
AB  - STUDY DESIGN: This was a retrospective study that was carried out using 
      prospectively collected registry data. OBJECTIVE: The objective of this study was 
      to identify preoperative predictors of outcomes after anterior cervical 
      discectomy and fusion (ACDF) for cervical spondylotic myelopathy. SUMMARY OF 
      BACKGROUND DATA: Proper patient selection is paramount to achieving good surgical 
      results. Identifying predictors of outcomes may aid surgical decision-making and 
      facilitate counseling of patients to manage expectations. METHODS: Prospectively 
      collected registry data of 104 patients who underwent single-level ACDF for 
      cervical spondylotic myelopathy were reviewed. Outcomes assessed at 2 years were 
      the presence of residual neck pain/arm pain (AP), and attainment of a minimal 
      clinically important difference (MCID) for Neck Disability Index (NDI), Japanese 
      Orthopaedic Association (JOA) score, and Physical Component Score (PCS) of SF-36, 
      as well as patient satisfaction, fulfilment of expectations, willingness to 
      undergo same surgery again, return to work (RTW), and return to function (RTF). 
      Receiver operating characteristic curves and multivariate stepwise logistical 
      regression were performed to identify independent predictors of each outcome 
      using 22 covariates including demographics, comorbidities, and preoperative 
      disease state. RESULTS: Lower preoperative NDI was predictive of the absence of 
      residual neck pain/AP at 2 years. Higher preoperative JOA score was predictive of 
      MCID attainment for PCS, satisfaction, expectation fulfilment, willingness to 
      undergo the same surgery for same condition, and RTF. Poorer preoperative scores 
      of NDI, JOA, and PCS were predictors of attaining MCID of the respective scores. 
      Older patients were less likely to attain MCID for JOA. Higher preoperative AP 
      was a risk factor for unsuccessful RTW. CONCLUSIONS: In general, the preoperative 
      JOA score was the best predictor of outcomes after ACDF. A preoperative JOA 
      cutoff value of 9.25-10.25 predicted satisfaction, expectation fulfilment, 
      willingness to undergo same surgery, and RTF with at least 70% sensitivity and 
      50% specificity. These findings may aid surgeons in identifying patients at risk 
      of a poor outcome and guide preoperative counseling to establish realistic 
      expectations of the surgical outcome. LEVEL OF EVIDENCE: Level III-Non-randomized 
      controlled cohort/follow-up study.
FAU - Goh, Graham S
AU  - Goh GS
AD  - Department of Orthopedic Surgery, Singapore General Hospital.
FAU - Liow, Ming Han Lincoln
AU  - Liow MHL
AD  - Department of Orthopedic Surgery, Singapore General Hospital.
FAU - Yeo, William
AU  - Yeo W
AD  - Department of Orthopedic Surgery, Singapore General Hospital.
FAU - Ling, Zhixing Marcus
AU  - Ling ZM
AD  - Department of Orthopedic Surgery, Singapore General Hospital.
FAU - Guo, Chang-Ming
AU  - Guo CM
AD  - Department of Orthopedic Surgery, Singapore General Hospital.
FAU - Yue, Wai-Mun
AU  - Yue WM
AD  - The Orthopaedic Centre.
FAU - Tan, Seang-Beng
AU  - Tan SB
AD  - Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, Singapore, 
      Singapore.
FAU - Chen, John Li-Tat
AU  - Chen JL
AD  - Department of Orthopedic Surgery, Singapore General Hospital.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Clin Spine Surg
JT  - Clinical spine surgery
JID - 101675083
SB  - IM
MH  - Cervical Vertebrae/surgery
MH  - Diskectomy
MH  - Follow-Up Studies
MH  - Humans
MH  - Multivariate Analysis
MH  - Neck Pain/surgery
MH  - Retrospective Studies
MH  - *Spinal Cord Diseases/surgery
MH  - *Spinal Fusion
MH  - Treatment Outcome
EDAT- 2020/04/30 06:00
MHDA- 2021/10/26 06:00
CRDT- 2020/04/30 06:00
PHST- 2020/04/30 06:00 [pubmed]
PHST- 2021/10/26 06:00 [medline]
PHST- 2020/04/30 06:00 [entrez]
AID - 01933606-202012000-00020 [pii]
AID - 10.1097/BSD.0000000000000997 [doi]
PST - ppublish
SO  - Clin Spine Surg. 2020 Dec;33(10):E525-E532. doi: 10.1097/BSD.0000000000000997.