PMID- 38364219 OWN - NLM STAT- MEDLINE DCOM- 20240501 LR - 20240501 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 40 IP - 5 DP - 2024 May 1 TI - Cervical spondylotic myelopathy and driving abilities: defining the prevalence and long-term postoperative outcomes using the Quality Outcomes Database. PG - 630-641 LID - 10.3171/2023.11.SPINE23738 [doi] AB - OBJECTIVE: Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and a subsequent reduction in an individual's quality of life due to neurological deterioration. The positive impact of surgery on postoperative patient-reported driving capabilities has been seldom explored. METHODS: The CSM module of the Quality Outcomes Database was utilized. Patient-reported driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire. This is an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to symptoms. Patients were considered to have an impairment in their driving ability if they reported an NDI driving score of 3 or higher (signifying impairment in driving duration due to symptoms). Multivariable logistic regression models were fitted to evaluate mediators of baseline impairment and improvement at 24 months after surgery, which was defined as an NDI driving score < 3. RESULTS: A total of 1128 patients who underwent surgical intervention for CSM were included, of whom 354 (31.4%) had baseline driving impairment due to CSM. Moderate (OR 2.3) and severe (OR 6.3) neck pain, severe arm pain (OR 1.6), mild-moderate (OR 2.1) and severe (OR 2.5) impairment in hand/arm dexterity, severe impairment in leg use/walking (OR 1.9), and severe impairment of urinary function (OR 1.8) were associated with impaired driving ability at baseline. Of the 291 patients with baseline impairment and available 24-month follow-up data, 209 (71.8%) reported postoperative improvement in their driving ability. This improvement seemed to be mediated particularly through the achievement of the minimal clinically important difference (MCID) in neck pain and improvement in leg function/walking. Patients with improved driving at 24 months noted higher postoperative satisfaction (88.5% vs 62.2%, p < 0.01) and were more likely to achieve a clinically significant improvement in their quality of life (50.7% vs 37.8%, p < 0.01). CONCLUSIONS: Nearly one-third of patients with CSM report impaired driving ability at presentation. Seventy-two percent of these patients reported improvements in their driving ability within 24 months of surgery. Surgical management of CSM can significantly improve patients' driving abilities at 24 months and hence patients' quality of life. FAU - Agarwal, Nitin AU - Agarwal N AD - 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. AD - 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. AD - 3Neurological Surgery, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. FAU - Johnson, Sarah E AU - Johnson SE AD - 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Bydon, Mohamad AU - Bydon M AD - 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Bisson, Erica F AU - Bisson EF AD - 5Department of Neurosurgery, University of Utah, Salt Lake City, Utah. FAU - Chan, Andrew K AU - Chan AK AD - 6Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York. FAU - Shabani, Saman AU - Shabani S AD - 7Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. FAU - Letchuman, Vijay AU - Letchuman V AD - 8Department of Neurosurgery, University of California, San Francisco, San Francisco, California. FAU - Michalopoulos, Giorgos D AU - Michalopoulos GD AD - 4Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Lu, Daniel C AU - Lu DC AD - 9Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California. FAU - Wang, Michael Y AU - Wang MY AD - 10Department of Neurological Surgery, University of Miami, Miami, Florida. FAU - Lavadi, Raj Swaroop AU - Lavadi RS AD - 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. FAU - Haid, Regis W AU - Haid RW AD - 11Atlanta Brain and Spine Care, Atlanta, Georgia. FAU - Knightly, John J AU - Knightly JJ AD - 12Atlantic Neurosurgical Specialists, Morristown, New Jersey. FAU - Sherrod, Brandon A AU - Sherrod BA AD - 5Department of Neurosurgery, University of Utah, Salt Lake City, Utah. FAU - Gottfried, Oren N AU - Gottfried ON AD - 13Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - 13Department of Neurosurgery, Duke University, Durham, North Carolina. FAU - Goldberg, Jacob L AU - Goldberg JL AD - 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York. FAU - Virk, Michael S AU - Virk MS AD - 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York. FAU - Hussain, Ibrahim AU - Hussain I AD - 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York. FAU - Glassman, Steven D AU - Glassman SD AD - 15Norton Leatherman Spine Center, Louisville, Kentucky. FAU - Shaffrey, Mark E AU - Shaffrey ME AD - 16Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. FAU - Park, Paul AU - Park P AD - 17Department of Neurosurgery, Semmes Murphey Clinic, University of Tennessee, Memphis, Tennessee. FAU - Foley, Kevin T AU - Foley KT AD - 17Department of Neurosurgery, Semmes Murphey Clinic, University of Tennessee, Memphis, Tennessee. FAU - Pennicooke, Brenton AU - Pennicooke B AD - 18Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri. FAU - Coric, Domagoj AU - Coric D AD - 19Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina. FAU - Slotkin, Jonathan R AU - Slotkin JR AD - 20Geisinger Health, Danville, Pennsylvania. FAU - Upadhyaya, Cheerag AU - Upadhyaya C AD - 21Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina. FAU - Potts, Eric A AU - Potts EA AD - 22Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana; and. FAU - Tumialan, Luis M AU - Tumialan LM AD - 23Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona. FAU - Chou, Dean AU - Chou D AD - 6Department of Neurosurgery, Columbia University Irving Medical Center, New York, New York. FAU - Fu, Kai-Ming G AU - Fu KG AD - 14Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York. FAU - Asher, Anthony L AU - Asher AL AD - 19Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina. FAU - Mummaneni, Praveen V AU - Mummaneni PV AD - 8Department of Neurosurgery, University of California, San Francisco, San Francisco, California. LA - eng PT - Journal Article DEP - 20240216 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Humans MH - Male MH - Female MH - *Automobile Driving MH - Middle Aged MH - *Spondylosis/surgery MH - *Cervical Vertebrae/surgery MH - Aged MH - *Quality of Life MH - Treatment Outcome MH - Prevalence MH - Spinal Cord Diseases/surgery MH - Disability Evaluation MH - Databases, Factual MH - Adult OTO - NOTNLM OT - Neck Disability Index OT - cervical spondylotic myelopathy OT - driving OT - patient-reported outcome measures EDAT- 2024/02/16 18:43 MHDA- 2024/05/02 00:48 CRDT- 2024/02/16 16:53 PHST- 2023/07/18 00:00 [received] PHST- 2023/11/28 00:00 [accepted] PHST- 2024/05/02 00:48 [medline] PHST- 2024/02/16 18:43 [pubmed] PHST- 2024/02/16 16:53 [entrez] AID - 10.3171/2023.11.SPINE23738 [doi] PST - epublish SO - J Neurosurg Spine. 2024 Feb 16;40(5):630-641. doi: 10.3171/2023.11.SPINE23738. Print 2024 May 1.