Impact of predominant symptom location among patients undergoing cervical spine surgery on 12-month outcomes: an analysis from the Quality Outcomes Database

OBJECTIVE The impact of the type of pain presentation on outcomes of spine surgery remains elusive. The aim of this study was to assess the impact of predominant symptom location (predominant arm pain vs predominant neck pain vs equal neck and arm pain) on postoperative improvement in patient-reported outcomes. METHODS The Quality Outcomes Database cervical spine module was queried for patients undergoing 1- or 2-level anterior cervical discectomy and fusion (ACDF) for degenerative spine disease. RESULTS A total of 9277 patients were included in the final analysis. Of these patients, 18.4% presented with predominant arm pain, 32.3% presented with predominant neck pain, and 49.3% presented with equal neck and arm pain. Patients with predominant neck pain were found to have higher (worse) 12-month Neck Disability Index (NDI) scores (coefficient 0.24, 95% CI 0.15–0.33; p < 0.0001). The three groups did not differ significantly in odds of return to work and achieving minimal clinically important difference in NDI score at the 12-month follow-up. CONCLUSIONS Analysis from a national spine registry showed significantly lower odds of patient satisfaction and worse NDI score at 1 year after surgery for patients with predominant neck pain when compared with patients with predominant arm pain and those with equal neck and arm pain after 1- or 2-level ACDF. With regard to return to work, all three groups (arm pain, neck pain, and equal arm and neck pain) were found to be similar after multivariable analysis. The authors’ results suggest that predominant pain location, especially predominant neck pain, might be a significant determinant of improvement in functional outcomes and patient satisfaction after ACDF for degenerative spine disease. In addition to confirmation of the common experience that patients with predominant neck pain have worse outcomes, the authors’ findings provide potential targets for improvement in patient management for these specific populations.

Download Full-text

Impact of Predominant Arm Pain vs Neck Pain on 12-Month Outcomes Following Elective Cervical Spine Surgery: Analysis From the Quality Outcomes Database (QOD)

Neurosurgery ◽

10.1093/neuros/nyz310_356 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Clinton J Devin ◽

Mohamad Bydon ◽

Mohammed A Alvi ◽

Anshit Goyal ◽

Panagiotis Kerezoudis ◽

...

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Degenerative Spine ◽

Quality Outcomes ◽

Degenerative Spine Disease ◽

Arm Pain ◽

Spine Registry ◽

Pain Location ◽

The Impact ◽

Spine Disease

Abstract INTRODUCTION The impact of the type of pain presentation on outcomes of spine surgery remains elusive. The severity of symptoms is a critical determinant for decision to operate among such patients. Herein, we present an analysis of the impact of predominant symptom location (arm pain vs neck pain) on postoperative improvement in patient reported outcomes. METHODS The Quality Outcomes Database (QOD) cervical spine registry was queried for patients undergoing 1 to 2 level ACDF for degenerative spine disease. Multivariable (MV) regression was performed to assess the impact of predominant pain location (arm pain vs neck pain vs equal arm and neck pain) on the following 12 mo outcomes following surgery-NASS satisfaction, Neck Disability Index (NDI) and return to work. RESULTS A total of 9277 patients were included in the final analysis. Of these, 18.4% (n = 1705) presented with predominant arm pain, 32.3% (n = 2994) presented with predominant neck pain, and 49.3% (n = 4578) presented with equal neck and arm pain. On MV analysis, patients with predominant neck pain were found to have lower odds of being satisfied at 1 yr following surgery (OR = 0.73, CI: 0.62-0.98, P < .001) while predominant arm pain was not significantly associated (OR = 1.04, CI: 0.6-1.4, P = .55, ref = equal neck and arm pain). On MV linear regression, patients with predominant neck pain had higher (worse) 12 mo NDI (Coef: 0.24, CI: 0.15-0.33, P < .0001) while predominant arm pain was not significantly associated with 12 mo NDI. Predominant arm pain (OR = 0.77, CI:0.64-1.02, P = .06) or neck pain (OR = 1.04, CI: 0.82-1.33, P = .6) were not significantly associated with return to work at 1 yr. CONCLUSION Analysis from a national spine registry suggests predominant pain location (arm pain vs neck pain) might be a significant determinant of improvement in functional outcomes and patient satisfaction following anterior cervical discectomy and fusion for degenerative spine disease.

Download Full-text

Understanding the Impact of Obesity on Short-term Outcomes and In-hospital Costs After Instrumented Spinal Fusion

Neurosurgery ◽

10.1227/neu.0000000000001018 ◽

2015 ◽

Vol 78 (1) ◽

pp. 127-132 ◽

Cited By ~ 28

Author(s):

Dominique M. Higgins ◽

Grant W. Mallory ◽

Ryan F. Planchard ◽

Ross C. Puffer ◽

Mohamed Ali ◽

...

Keyword(s):

Morbid Obesity ◽

Spinal Fusion ◽

Cost Of Care ◽

Wound Complications ◽

Morbidly Obese ◽

Obese Patients ◽

Degenerative Spine ◽

Degenerative Spine Disease ◽

The Impact ◽

Spine Disease

Abstract BACKGROUND: Obesity rates continue to rise along with the number of obese patients undergoing elective spinal fusion. OBJECTIVE: To evaluate the impact of obesity on resource utilization and early complications in patients undergoing surgery for degenerative spine disease. METHODS: A single-institution retrospective analysis was conducted on patients with degenerative spine disease requiring instrumentation between 2008 and 2012. The 801 identified patients were grouped based on a body mass index (BMI) of <30 (nonobese, n = 478), ≥30 and <40 (obese, n = 283), and alternatively BMIs of ≥40 (morbidly obese, n = 40). Baseline characteristics, surgical outcomes and requirements, complications, and cost were compared. Logistic and linear regression analyses were used to determine the strength of association between obesity and outcomes for categorical and continuous data, respectively. RESULTS: Significant differences were found in comorbidities between cohorts. Multivariate analysis revealed significant associations between obesity and longer anesthesia times (30 minutes, P = .008), and surgical times (24 minutes, P = .02). Additionally, there was a 2.8 times higher rate of wound complications in obese patients (4.2% vs 1.5, P = .03), and 2.5 times higher rate of major medical complications (7.8% vs 3.1, P = .01). Morbid obesity resulted in a 10 times higher rate of wound complications (P < .001). Morbid obesity resulted in a $9078 (P = .005) increase in overall cost of care. CONCLUSION: Increased BMI is associated with longer operative times, increased complication rates, and increased cost independent of comorbidities. These effects are more pronounced with morbidly obese patients, further supporting a role for preoperative weight loss.

Download Full-text

Intradural Spinal Tumor and Degenerative Spine Disease in Patients with Back Pain: Treatment Strategies

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0032-1316235 ◽

2012 ◽

Vol 73 (S 03) ◽

Author(s):

D. Bellut ◽

U. Mutter ◽

M. Sutter ◽

A. Eggspuehler ◽

A. Mannion ◽

...

Keyword(s):

Back Pain ◽

Pain Treatment ◽

Treatment Strategies ◽

Spinal Tumor ◽

Degenerative Spine ◽

Degenerative Spine Disease ◽

Spine Disease

Download Full-text

Treatment of Refractory Low Back Pain Caused by Degenerative Spine Disease with Minimally Invasive Techniques

Global Spine Journal ◽

10.1055/s-0034-1376724 ◽

2014 ◽

Vol 4 (1_suppl) ◽

pp. s-0034-1376724-s-0034-1376724

Author(s):

K. Vladimirovich Tyulikov ◽

K. Korostelev ◽

V. Manukovsky ◽

V. Litvinenko ◽

V. Badalov

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Minimally Invasive ◽

Low Back ◽

Minimally Invasive Techniques ◽

Degenerative Spine ◽

Degenerative Spine Disease ◽

Invasive Techniques ◽

Spine Disease

Download Full-text

Validity and Reliability of an Objective Measurement of Functional Impairment in Lumbar Degenerative Spine Disease: The Timed-Up-and-Go (TUG) Test

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0035-1564542 ◽

2015 ◽

Vol 76 (S 01) ◽

Author(s):

O. Gautschi ◽

N. Smoll ◽

M. Corniola ◽

H. Joswig ◽

I. Chau ◽

...

Keyword(s):

Functional Impairment ◽

Objective Measurement ◽

Validity And Reliability ◽

Degenerative Spine ◽

Timed Up And Go ◽

Degenerative Spine Disease ◽

Spine Disease

Download Full-text

The Prevalence of Sarcopenia and Its Impact on Clinical Outcomes in Lumbar Degenerative Spine Disease—A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10040773 ◽

2021 ◽

Vol 10 (4) ◽

pp. 773

Author(s):

Wei-Ting Wu ◽

Tsung-Min Lee ◽

Der-Sheng Han ◽

Ke-Vin Chang

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Clinical Manifestations ◽

Current Evidence ◽

Degenerative Spine ◽

Degenerative Spine Disease ◽

Spine Disease

The association of sarcopenia with poor clinical outcomes has been identified in various medical conditions, although there is a lack of quantitative analysis to validate the influence of sarcopenia on patients with lumbar degenerative spine disease (LDSD) from the available literature. Therefore, this systematic review and meta-analysis aimed to summarize the prevalence of sarcopenia in patients with LDSD and examine its impact on clinical outcomes. The electronic databases (PubMed and Embase) were systematically searched from inception through December 2020 for clinical studies investigating the association of sarcopenia with clinical outcomes in patients with LDSD. A random-effects model meta-analysis was carried out for data synthesis. This meta-analysis included 14 studies, comprising 1953 participants. The overall prevalence of sarcopenia among patients with LDSD was 24.8% (95% confidence interval [CI], 17.3%–34.3%). The relative risk of sarcopenia was not significantly increased in patients with LDSD compared with controls (risk ratio, 1.605; 95% CI, 0.321–8.022). The patients with sarcopenia did not experience an increase in low back and leg pain. However, lower quality of life (SMD, −0.627; 95% CI, −0.844–−0.410) were identified postoperatively. Sarcopenia did not lead to an elevated rate of complications after lumbar surgeries. Sarcopenia accounts for approximately one-quarter of the population with LDSD. The clinical manifestations are less influenced by sarcopenia, whereas sarcopenia is associated with poorer quality of life after lumbar surgeries. The current evidence is still insufficient to support sarcopenia as a predictor of postoperative complications.

Download Full-text