Does Neck Disability Index Correlate With 12-Month Satisfaction After Elective Surgery for Cervical Radiculopathy? Results From a National Spine Registry

Abstract BACKGROUND Modern healthcare reforms focus on identifying and measuring the quality and value of care. Patient satisfaction is particularly important in the management of degenerative cervical radiculopathy (DCR) since it leads to significant neck pain and disability primarily affecting the patients’ quality of life. OBJECTIVE To determine the association of baseline and 12-mo Neck Disability Index (NDI) with patient satisfaction after elective surgery for DCR. METHODS The Quality Outcomes Database cervical module was queried for patients who underwent elective surgery for DCR. A multivariable proportional odds regression model was fitted with 12-mo satisfaction as the outcome. The covariates for this model included patients’ demographics, surgical characteristics, and baseline and 12-mo patient reported outcomes (PROs). Wald-statistics were calculated to determine the relative importance of each independent variable for 12-mo patient satisfaction. RESULTS The analysis included 2206 patients who underwent elective surgery for DCR. In multivariable analysis, after adjusting for baseline and surgery specific variables, the 12-mo NDI score showed the highest association with 12-mo satisfaction (Waldχ2-df = 99.17, 58.1% of total χ2). The level of satisfaction increases with decrease in 12-mo NDI score regardless of the baseline NDI score. CONCLUSION Our study identifies 12-mo NDI score as a very influential driver of 12-mo patient satisfaction after surgery for DCR. In addition, there are lesser contributions from other 12-mo PROs, baseline Numeric Rating Scale for arm pain and American Society of Anesthesiologists (ASA) grade. The baseline level of disability was found to be irrelevant to patients. They seemed to only value their current level of disability, compared to baseline, in rating satisfaction with surgical outcome.

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A Randomized Comparative Trial of Targeted Steroid Injection via Epidural Catheter vs Standard Transforaminal Epidural Injection for the Treatment of Unilateral Cervical Radicular Pain: Six-Month Results

Pain Medicine ◽

10.1093/pm/pnaa242 ◽

2020 ◽

Vol 21 (10) ◽

pp. 2077-2089 ◽

Cited By ~ 1

Author(s):

Zachary L McCormick ◽

Aaron Conger ◽

Beau P Sperry ◽

Masaru Teramoto ◽

Russell Petersen ◽

...

Keyword(s):

Rating Scale ◽

Steroid Injection ◽

Neck Disability Index ◽

Comparative Trial ◽

Epidural Injection ◽

Cervical Radiculopathy ◽

Numeric Rating Scale ◽

Radicular Pain ◽

Interlaminar Epidural Steroid Injection ◽

Neck Disability

Abstract Objectives Compare the effectiveness of catheter-directed cervical interlaminar epidural steroid injection (C-CIESI) with triamcinolone to cervical transforaminal steroid injection (CTFESI) with dexamethasone for the treatment of refractory unilateral radicular pain. Design Prospective, randomized, comparative trial. Methods Primary outcome: proportion of participants with ≥50% numeric rating scale pain score reduction from baseline “dominant pain” (the greater of arm vs neck) at one month postinjection. Secondary outcomes: ≥30% Neck Disability Index (NDI-5) reduction and Patient Global Impression of Change (PGIC) response indicating “much improved” or “very much improved.” Results One hundred twenty participants (55.6% females, 52.3 ± 12.5 years of age, BMI 28.2 ± 6.5 kg/m2), were enrolled. The proportions of participants who experienced ≥50% pain reduction at one, three, and six months were 68.5% (95% CI = 54.9–79.5%), 59.3% (95% CI = 45.7–71.6%), and 60.8% (95% CI = 46.7–73.2%), respectively, in the C-CIESI group compared with 49.1% (95% CI = 36.4–62.0%), 46.4% (95% CI = 33.8–59.6%), and 51.9% (95% CI = 38.4–65.2%), respectively, in the CTFESI group. The between-group difference at one month was significant (P = 0.038). The proportions of participants who experienced a ≥30% NDI-5 score improvement were 64.0% (95% CI = 49.8–76.1%) and 54.9% (95% CI = 41.1–68.0%) in the C-CIESI and CTFESI groups (P = 0.352). Participants reported similar PGIC improvement in both groups: At six months, 53.2% (95% CI 38.9–67.1%) and 54.5% (95% CI = 39.7–68.7%) of the C-CIESI and CTFESI groups reported being “much improved” or “very much improved,” respectively (P = 0.897). Conclusions Both C-CIESI with triamcinolone and CTFESI with dexamethasone are effective in reducing pain and disability associated with refractory unilateral cervical radiculopathy in a substantial proportion of participants for at least six months.

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Patient-Reported Outcomes and Patient-Reported Satisfaction After Surgical Treatment for Cervical Radiculopathy

Global Spine Journal ◽

10.1177/2192568218765398 ◽

2018 ◽

Vol 8 (7) ◽

pp. 703-708 ◽

Cited By ~ 12

Author(s):

Andreas Kiilerich Andresen ◽

Rune Tendal Paulsen ◽

Frederik Busch ◽

Alexander Isenberg-Jørgensen ◽

Leah Y. Carreon ◽

...

Keyword(s):

Short Form ◽

Neck Disability Index ◽

Visual Analogue Score ◽

Cervical Radiculopathy ◽

Strongly Correlated ◽

Anterior Cervical Decompression ◽

Sf 36 ◽

Patient Reported ◽

Neck Disability ◽

Cervical Degenerative Disease

Study Design: Retrospective cohort study. Objectives: It is estimated that 10 000 patients seek medical care due to cervical radiculopathy every year in Denmark. Although the natural course is usually favorable, around 20% undergo surgery for cervical degenerative disease every year in Denmark. We aim to evaluate the patient-reported results and satisfaction of anterior cervical decompression and fusion over a 5-year period from a single Danish center for spine surgery. Methods: This study is a retrospective study based on prospectively collected data from 318 consecutive patients treated with anterior cervical decompression and fusion over 1 to 3 levels. Data in the DaneSpine registry was collected pre- and postoperatively, and at 1 year after surgery. The outcome measures were Neck Disability Index (NDI), European Quality of Life 5D (EQ-5D), visual analogue score (VAS), and Short Form-36 Physical Component Summary (SF-36 PCS). Results: Of 318 cases enrolled, 272 (85.5%) had follow-up data available at a minimum 1-year postoperatively. The mean preoperative NDI was 40.0 and improved to 22.7. Mean EQ-5D was 0.50 and improved to 0.70, and mean VAS arm was 60.4 improved to 26.4. All improvements were statistically significant. A total of 74.3% were back to work 1 year after surgery. Achieving minimal clinically important difference (MCID) in VAS neck and SF-36 PCS was strongly correlated to patient satisfaction. Conclusion: Patients who undergo anterior cervical discectomy and fusion can expect improvement in their pain and disability, with 74.3% of patients reporting a positive change in health status after surgery.

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Effectiveness of Neural Mobilization on Pain, Range of motion, and Disability in Cervical Radiculopathy: a Randomized Controlled Trial

10.21203/rs.3.rs-223383/v1 ◽

2021 ◽

Author(s):

Shazia Rafiq ◽

Hamayun Zafar ◽

Prof. Dr. Syed Amir Gillani ◽

Muhammad Sharif Waqas ◽

Amna Zia ◽

...

Keyword(s):

Conservative Treatment ◽

Pain Intensity ◽

Range Of Motion ◽

Conventional Treatment ◽

Rating Scale ◽

Controlled Trial ◽

Neck Disability Index ◽

Sampling Technique ◽

Cervical Radiculopathy ◽

Neck Disability

Abstract Background: Cervical Radiculopathy (CR) is a disorder of the spinal nerve roots that is largely caused by space occupying lesion which can lead to nerve root inflammation and patient usually presents with radiating pain in his/her upper extremity known as cervical radiculopathy. The objective of the study was to compare the effectiveness of neural mobilization technique with conservative treatment on pain intensity, range of motion and disability.Methods: It was a double blinded randomized clinical trial; data was collected from Mayo Hospital, Lahore through convenience sampling technique. After taking consent from the patients, the patients fulfilling the inclusion and exclusion criteria were selected and randomized blindly and assigned through computer generated random number into two groups i.e. group 1 (neural mobilization), group 2 (conventional treatment). Pain intensity was measured on Numeric pain rating scale, range of motion measured with inclinometer and functional status with neck disability index (NDI). Data was analyzed using SPSS and difference in improvement before, after 02 and 04 weeks was noted and compared. Results: There was significant improvement in pain relief, neck disability and cervical ranges after the treatment in both groups compared to the pre-treatment status (p < 0.00) and when neural mobilization was compared , it was more effective technique than conventional treatment in reducing pain and neck disability (p < 0.00). But there was not statistical difference in mean score of cervical range of motion (p>0.05)Conclusions: The present study concluded that both neural mobilization and conservative treatment were effective as an exercise program for patient with cervical radiculopathy, however neural mobilization was more effective in reducing pain and neck disability in cervical radiculopathy.Trial registration: RCT20190325043109N1

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Neck Pain and Disability: Are They Related to Dysfunctional Breathing and Stress?

Physiotherapy Canada ◽

10.3138/ptc-2020-0085 ◽

2021 ◽

Author(s):

Sarah Stephen ◽

Corlia Brandt ◽

Benita Olivier

Keyword(s):

Neck Pain ◽

Rating Scale ◽

Hold Time ◽

Neck Disability Index ◽

Numeric Rating Scale ◽

Cross Sectional Study ◽

Breath Hold ◽

Cross Sectional ◽

Dysfunctional Breathing ◽

Neck Disability

Purpose: People with neck pain are likely to have negative respiratory findings. The purpose of this study was to investigate the relationship between neck pain and dysfunctional breathing and to examine their relationship to stress. Method: This cross-sectional study included 49 participants with neck pain and 49 age- and sex-matched controls. We measured neck pain using the numeric rating scale (NRS); neck disability using the Neck Disability Index (NDI); dysfunctional breathing using the Nijmegen Questionnaire (NQ), Self-Evaluation of Breathing Questionnaire (SEBQ), breath hold time, and respiratory rate (RR); and stress using the Perceived Stress Scale (PSS). Results:Participants with neck pain scored higher on the NQ ( p < 0.001) and the SEBQ ( p < 0.001) than controls. NQ and SEBQ scores correlated moderately with NDI scores ( r > 0.50; 95% CI: 0.25, 0.68 and 0.33, 0.73, respectively) and PSS scores ( r > 0.50; 95% CI: 0.29, 0.78 and 0.31, 0.73, respectively). SEBQ scores showed a fair correlation with NRS scores and RR a fair correlation with NDI scores. Conclusions: Participants with neck pain had more dysfunctional breathing symptoms than participants without neck pain, and dysfunctional breathing was correlated with increased neck disability and increased stress. The NQ and SEBQ can be useful in assessing dysfunctional breathing in patients with neck pain.

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P.229 Epidemiology and Outcomes of Neck Pain Following Surgery for Degenerative Cervical Radiculopathy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.520 ◽

2021 ◽

Vol 48 (s3) ◽

pp. S86-S86

Author(s):

MA MacLean ◽

A Dakson ◽

F Xavier ◽

SD Christie ◽

C Investigators

Keyword(s):

Neck Pain ◽

Short Form ◽

Neck Disability Index ◽

Cervical Radiculopathy ◽

Research Network ◽

Cervical Disc ◽

Cervical Disc Arthroplasty ◽

Arm Pain ◽

Composite Scale ◽

Neck Disability

Background: Many studies have demonstrated improved arm pain (AP) following surgery for degenerative cervical radiculopathy (DCR); however, axial neck pain (NP) is generally not felt to improve. The purpose of this study was to determine whether surgery for DCR improves NP. Methods: A ambispective cohort study of the Canadian Spine Outcomes Research Network (CSORN) registry for patients who received 1-level, 2-level, 3-level ADCF (anterior cervical discectomy and fusion) or cervical disc arthroplasty (CDA) for DCR. Outcomes: 12-month post-operative Visual Analogue Scale for NP (VAS-NP), Neck Disability Index (NDI), VAS for AP (VAS-AP), Short-Form Physical Health Composite Scale (SF36-PCS), and Mental Health Composite Scale (SF36-MCS). Results: We identified 603 patients with DCR. CDA patients were the youngest (ANOVA; p<0.001). Patients reported similar pre-operative AP, NP, disability, and health-related quality of life, regardless of procedure (ANOVA; all P>0.05). All procedures offered a statistically significant reduction in VAS-NP, VAS-AP, and NDI (ANOVA; all P<0.001). Mean change from baseline in NP, AP, and disability, were similar across procedures. At 12 months, mean reduction in VAS-AP, VAS-NP, and NDI exceeded minimal clinically important differences for nearly all procedures. Conclusions: Patients undergoing surgery for DCR can expect a clinically significant, approximate 50% reduction in NP, AP, and neck-related disability.

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STAND-ALONE CERVICAL CAGE FOR CERVICAL RADICULOPATHY: A RETROSPECTIVE STUDY

(JOINTS) Journal Orthopaedi and Traumatology Surabaya ◽

10.20473/joints.v9i1.2020.17-21 ◽

2020 ◽

Vol 9 (1) ◽

pp. 17

Author(s):

I Ketut Martiana ◽

Reyner Valiant Tumbelaka

Keyword(s):

Neck Disability Index ◽

Cervical Radiculopathy ◽

Surgical Method ◽

Arm Pain ◽

Phone Calls ◽

Specific Muscle ◽

Muscle Groups ◽

Hospital Institution ◽

Neck Disability

Introduction: Cervical radiculopathy is a clinical condition characterized by unilateral arm pain, numbness and tingling in a dermatomal distribution in the hand, and weakness in specific muscle groups that can be treated with nonsurgical or surgical method. This study aims to evaluate the outcome of the stand-alone cervical cage surgical method for cervical radiculopathy in our hospital institution from 2013 to 2017Methods: This is a retrospective observational study on every patient who undergoes a stand-alone cervical cage for cervical radiculopathy in our hospital institution from 2013 to 2017. The study runs from December 2017 until April 2018. We evaluated the clinical outcome with the Neck Disability Index (NDI). The data were collected from medical records, and postoperative follow up is done by house visits, phone calls, and outpatient visits.Results: Five male and one female subjects with a mean age of 58 years old (45–65 years old) underwent the procedure; one patient passed away on three year postoperative due to other events not related to operation procedure; one patient could no longer be reached. Four patient has an increasing score of NDI postoperative. There is no postoperative complicationConclusion: Stand-alone cervical cage is an excellent treatment for cervical radiculopathy in our hospital institution from 2013 to 2017.

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Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients

Neurospine ◽

10.14245/ns.2040456.228 ◽

2021 ◽

Vol 18 (3) ◽

pp. 628-634

Author(s):

Peter G. Passias ◽

Katherine E. Pierce ◽

Nicholas Kummer ◽

Oscar Krol ◽

Lara Passfall ◽

...

Keyword(s):

Rating Scale ◽

Numerical Rating Scale ◽

Japanese Orthopaedic Association ◽

Neck Disability Index ◽

Cord Compression ◽

Patient Reported ◽

Numerical Rating ◽

Euroqol 5D ◽

Group 2 ◽

Neck Disability

Objective: Malalignment of the cervical spine can result in cord compression, leading to a myelopathy diagnosis. Whether deformity or myelopathy severity is stronger predictors of surgical outcomes is understudied.Methods: Surgical cervical deformity (CD) patients with baseline (BL) and up to 1-year data were included. Modified Japanese Orthopaedic Association (mJOA) score categorized BL myelopathy (mJOA = 18 excluded), with moderate myelopathy mJOA being 12 to 17 and severe myelopathy being less than 12. BL deformity severity was categorized using the mismatch between T1 slope and cervical lordosis (TS-CL), with CL being the angle between the lower endplates of C2 and C7. Moderate deformity was TS-CL less than or equal to 25° and severe deformity was greater than 25°. Categorizations were combined into 4 groups: group 1 (G1), severe myelopathy and severe deformity; group 2 (G2), severe myelopathy and moderate deformity; group 3 (G3), moderate myelopathy and moderate deformity; group 4 (G4), moderate myelopathy and severe deformity. Univariate analyses determined whether myelopathy or deformity had greater impact on outcomes.Results: One hundred twenty-eight CD patients were included (mean age, 56.5 years; 46% female; body mass index, 30.4 kg/m2) with a BL mJOA score of 12.8 ± 2.7 and mean TS-CL of 25.9° ± 16.1°. G1 consisted of 11.1% of our CD population, with 21% in G2, 34.6% in G3, and 33.3% in G4. At BL, Neck Disability Index (NDI) was greatest in G2 (p = 0.011). G4 had the lowest EuroQol-5D (EQ-5D) (p < 0.001). Neurologic exam factors were greater in severe myelopathy (p < 0.050). At 1-year, severe deformity met minimum clinically important differences (MCIDs) for NDI more than moderate deformity (p = 0.002). G2 had significantly worse outcomes compared to G4 by 1-year NDI (p = 0.004), EQ-5D (p = 0.028), Numerical Rating Scale neck (p = 0.046), and MCID for NDI (p = 0.001).Conclusion: Addressing severe deformity had increased clinical weight in improving patient-reported outcomes compared to addressing severe myelopathy.

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Cellular allograft for multilevel stand-alone anterior cervical discectomy and fusion

Neurosurgical FOCUS ◽

10.3171/2021.3.focus2150 ◽

2021 ◽

Vol 50 (6) ◽

pp. E7

Author(s):

Alec W. Gibson ◽

Abdullah H. Feroze ◽

Madeline E. Greil ◽

Margaret E. McGrath ◽

Sananthan Sivakanthan ◽

...

Keyword(s):

Neck Disability Index ◽

Bone Allograft ◽

Cervical Radiculopathy ◽

Anterior Cervical Discectomy ◽

High Rate ◽

Cervical Discectomy ◽

Arm Pain ◽

Scale Scores ◽

Neck Disability

OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is the most common treatment for degenerative disease of the cervical spine. Given the high rate of pseudarthrosis in multilevel stand-alone ACDF, there is a need to explore the utility of novel grafting materials. In this study, the authors present a single-institution retrospective study of patients with multilevel degenerative spine disease who underwent multilevel stand-alone ACDF surgery with or without cellular allograft supplementation. METHODS In a prospectively collected database, 28 patients who underwent multilevel ACDF supplemented with cellular allograft (ViviGen) and 25 patients who underwent multilevel ACDF with decellularized allograft between 2014 and 2020 were identified. The primary outcome was radiographic fusion determined by a 1-year follow-up CT scan. Secondary outcomes included change in Neck Disability Index (NDI) scores and change in visual analog scale scores for neck and arm pain. RESULTS The study included 53 patients with a mean age of 53 ± 0.7 years who underwent multilevel stand-alone ACDF encompassing 2.6 ± 0.7 levels on average. Patient demographics were similar between the two cohorts. In the cellular allograft cohort, 2 patients experienced postoperative dysphagia that resolved by the 3-month follow-up. One patient developed cervical radiculopathy due to graft subsidence and required a posterior foraminotomy. At the 1-year CT, successful fusion was achieved in 92.9% (26/28) of patients who underwent ACDF supplemented with cellular allograft, compared with 84.0% (21/25) of patients who underwent ACDF without cellular allograft. The cellular allograft cohort experienced a significantly greater improvement in the mean postoperative NDI score (p < 0.05) compared with the other cohort. CONCLUSIONS Cellular allograft is a low-morbidity bone allograft option for ACDF. In this study, the authors determined favorable arthrodesis rates and functional outcomes in a complex patient cohort following multilevel stand-alone ACDF supplemented with cellular allograft.

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Preoperative opioid strength may not affect outcomes of anterior cervical procedures: a post hoc analysis of 2 prospective, randomized trials

Journal of Neurosurgery Spine ◽

10.3171/2015.1.spine14985 ◽

2015 ◽

Vol 23 (4) ◽

pp. 484-489 ◽

Cited By ~ 9

Author(s):

Michael P. Kelly ◽

Paul A. Anderson ◽

Rick C. Sasso ◽

K. Daniel Riew

Keyword(s):

Rating Scale ◽

Short Form ◽

Neck Disability Index ◽

Numeric Rating Scale ◽

Success Rates ◽

Opioid Use ◽

Arm Pain ◽

Sf 36 ◽

Scale Scores ◽

Cervical Disease

OBJECT The aim of this study is to evaluate the relationship between preoperative opioid strength and outcomes of anterior cervical decompressive surgery. METHODS A retrospective cohort of 1004 patients enrolled in 1 of 2 investigational device exemption studies comparing cervical total disc arthroplasty (TDA) and anterior cervical discectomy and fusion (ACDF) for single-level cervical disease causing radiculopathy or myelopathy was selected. At a preoperative visit, opioid use data, Neck Disability Index (NDI) scores, 36-Item Short-Form Health Survey (SF-36) scores, and numeric rating scale scores for neck and arm pain were collected. Patients were divided into strong (oxycodone/morphine/meperidine), weak (codeine/propoxyphene/hydrocodone), and opioid-naïve groups. Preoperative and postoperative (24 months) outcomes scores were compared within and between groups using the paired t-test and ANCOVA, respectively. RESULTS Patients were categorized as follows: 226 strong, 762 weak, and 16 opioid naïve. The strong and weak groups were similar with respect to age, sex, race, marital status, education level, Worker’s Compensation status, litigation status, and alcohol use. At 24-month follow-up, no differences in change in arm or neck pain scores (arm: strong −52.3, weak −50.6, naïve −54.0, p = 0.244; neck: strong −52.7, weak −50.8, naïve −44.6, p = 0.355); NDI scores (strong −36.0, weak −33.3, naïve −32.3, p = 0.181); or SF-36 Physical Component Summary scores (strong: 14.1, weak 13.3, naïve 21.7, p = 0.317) were present. Using a 15-point improvement in NDI to determine success, the authors found no between-groups difference in success rates (strong 80.6%, weak 82.7%, naïve 73.3%, p = 0.134). No difference existed between treatment arms (TDA vs ACDF) for any outcome at any time point. CONCLUSIONS Preoperative opioid strength did not adversely affect outcomes in this analysis. Careful patient selection can yield good results in this patient population.

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