Cha Elliot D K, Lynch Conor P, Mohan Shruthi, Geoghegan Cara E, Jadczak Caroline N, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Neurospine. 2021 Jun;18(2):377-388. doi: 10.14245/ns.2142084.042. Epub 2021 Jun 30.
Our study aims to evaluate the impact of severity of preoperative Neck Disability Index (NDI) on postoperative patient-reported outcome measures (PROMs).
A retrospective review of primary, elective, single or multilevel anterior cervical discectomy and fusion or cervical disc arthroplasty procedures between 2013 and 2019 was performed. Visual analogue scale (VAS) neck and arm, NDI, 12-item Short Form physical and mental composite score (SF-12 PCS and MCS), Patient-Reported Outcome Measurement Information System physical function, and 9-item Patient Health Questionnaire (PHQ-9) were collected preoperatively and postoperatively. Patients were categorized by preoperative NDI: none-to-mild disability ( < 30); moderate disability ( ≥ 30 to < 50); severe disability ( ≥ 50 to < 70); complete disability ( ≥ 70). The impact of preoperative NDI on PROM scores and minimum clinically important difference (MCID) achievement rates were evaluated.
The cohort included 74 patients with none-to-mild disability, 95 moderate, 76 severe, and 17 with complete disability. Patients with greater preoperative disability demonstrated significantly different scores for NDI, VAS neck, SF-12 MCS, and PHQ-9 at all timepoints (p < 0.001). Patients with more severe disability demonstrated different magnitudes of improvement for NDI (all p < 0.001), VAS neck (p ≤ 0.009), VAS arm (p = 0.025), and PHQ-9 (p ≤ 0.011). The effect of preoperative severity on MCID achievement was demonstrated for NDI and for PHQ-9 (p ≤ 0.007).
Patients with severe neck disability demonstrated differences in pain, disability, physical and mental health. MCID achievement also differed by preoperative symptoms severity. Patients with more severe neck disability may be limited to the degree of improvement in quality of life but perceive them as significant changes.
本研究旨在评估术前颈部功能障碍指数（NDI）的严重程度对术后患者报告结局指标（PROMs）的影响。
对2013年至2019年间进行的原发性、择期、单节段或多节段颈椎前路椎间盘切除融合术或颈椎间盘置换术进行回顾性研究。术前和术后收集视觉模拟量表（VAS）颈部和手臂评分、NDI、12项简短形式身体和心理综合评分（SF-12 PCS和MCS）、患者报告结局测量信息系统身体功能评分以及9项患者健康问卷（PHQ-9）。根据术前NDI对患者进行分类：无至轻度残疾（<30）；中度残疾（≥30至<50）；重度残疾（≥50至<70）；完全残疾（≥70）。评估术前NDI对PROM评分和最小临床重要差异（MCID）达成率的影响。
该队列包括74例无至轻度残疾患者、95例中度残疾患者、76例重度残疾患者和17例完全残疾患者。术前残疾程度较高的患者在所有时间点的NDI、VAS颈部评分、SF-12 MCS和PHQ-9评分均有显著差异（p<0.001）。残疾程度更严重的患者在NDI（所有p<0.001）、VAS颈部评分（p≤0.009）、VAS手臂评分（p = 0.025）和PHQ-9评分（p≤0.011）方面的改善幅度不同。术前严重程度对NDI和PHQ-9的MCID达成情况有影响（p≤0.007）。
颈部残疾严重的患者在疼痛、残疾、身心健康方面存在差异。MCID的达成情况也因术前症状严重程度而异。颈部残疾更严重的患者生活质量的改善程度可能有限，但他们将这些改善视为显著变化。
