Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
World Neurosurg. 2022 Apr;160:e288-e295. doi: 10.1016/j.wneu.2022.01.001. Epub 2022 Jan 10.
To assess differences in postoperative patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) attainment following single-level anterior cervical discectomy and fusion based on predominant preoperative pain symptom.
Patients undergoing primary, single-level anterior cervical discectomy and fusion were identified. PROMs included visual analog scale (VAS) arm and neck, 12-item short-form physical component summary (SF-12 PCS), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), and Neck Disability Index, collected preoperatively and postoperatively. Patients were placed in preoperative predominant arm pain (pAP) and preoperative predominant neck pain groups. χ test compared demographic and perioperative characteristics, and MCID attainment rates. Student t test evaluated change from preoperative to postoperative PROM values and compared PROMs between groups.
There were 110 patients assessed (52 neck pain, 58 arm pain). Patients with preoperative predominant neck pain improved significantly from preoperative to postoperative at 12 weeks to 1 year for PROMIS-PF, 6 months and 1 year for SF-12 PCS, 6 weeks to 1 year for VAS neck, 6 weeks to 6 months for VAS arm, and 6 weeks to 2 years for Neck Disability Index (all P ≤ 0.035). Patients with pAP improved significantly from preoperative to all postoperative time points for PROMIS-PF, 6 months to 2 years for SF-12 PCS, 6 weeks to 1 year for VAS neck, 6 weeks to 1 year for VAS arm, and 6 weeks to 6 months for Neck Disability Index (all P ≤ 0.040). Mean PROMIS-PF was higher at 6 weeks, preoperative VAS neck was lower, and preoperative VAS arm was higher for pAP patients (all P ≤ 0.013). MCID attainment was significantly higher in pAP patients for PROMIS-PF from 6 weeks to 6 months, SF-12 PCS 6 weeks, and VAS arm 12 weeks.
Predominant pain symptom demonstrated little effect on perioperative characteristics and postoperative PROMs. Anterior cervical discectomy and fusion candidates will likely experience similar clinically meaningful postoperative improvements in physical function, disability, and pain.
根据主要术前疼痛症状，评估单节段前路颈椎间盘切除融合术后患者报告的结局测量（PROMs）和最小临床重要差异（MCID）的差异。
确定接受原发性单节段前路颈椎间盘切除融合术的患者。PROMs 包括视觉模拟量表（VAS）手臂和颈部、12 项简明健康状况调查问卷物理成分量表（SF-12 PCS）、患者报告结局测量信息系统物理功能（PROMIS-PF）和颈部残疾指数，分别在术前和术后采集。患者分为术前主要手臂疼痛（pAP）和术前主要颈部疼痛组。卡方检验比较人口统计学和围手术期特征以及 MCID 达标率。学生 t 检验评估术前至术后 PROM 值的变化，并比较组间 PROMs。
共评估了 110 例患者（52 例颈部疼痛，58 例手臂疼痛）。术前主要颈部疼痛患者在术后 12 周至 1 年时，PROMIS-PF、术后 6 个月和 1 年时 SF-12 PCS、术后 6 周至 1 年时 VAS 颈部、术后 6 周至 6 个月时 VAS 手臂、术后 6 周至 2 年时颈部残疾指数显著改善（均 P≤0.035）。pAP 患者在术后所有时间点 PROMIS-PF、术后 6 个月至 2 年 SF-12 PCS、术后 6 周至 1 年 VAS 颈部、术后 6 周至 1 年 VAS 手臂、术后 6 周至 6 个月颈部残疾指数均显著改善（均 P≤0.040）。pAP 患者的术前 VAS 颈部较低，术前 PROMIS-PF 较高，术后 6 周 VAS 手臂较高（均 P≤0.013）。pAP 患者在术后 6 周至 6 个月 PROMIS-PF、术后 6 周 SF-12 PCS 和术后 12 周 VAS 手臂的 MCID 达标率显著较高。
主要疼痛症状对围手术期特征和术后 PROMs 影响不大。前路颈椎间盘切除融合术候选者可能会经历类似的具有临床意义的术后身体功能、残疾和疼痛改善。
