Shahi Pratyush, Subramanian Tejas, Singh Nishtha, Shinn Daniel, Dalal Sidhant, Song Junho, Araghi Kasra, Melissaridou Dimitra, Sheha Evan, Dowdell James, Qureshi Sheeraz A, Iyer Sravisht
Hospital for Special Surgery, New York, NY.
Weill Cornell Medical College, New York, NY.
Spine (Phila Pa 1976). 2023 Jun 1;48(11):766-771. doi: 10.1097/BRS.0000000000004493. Epub 2022 Sep 21.
Retrospective review of prospectively collected data.
To determine the Neck Disability Index (NDI) cut-off for achieving patient acceptable symptom state (PASS) at six months following degenerative cervical spine surgery.
An absolute score denoting PASS might be a better marker to assess clinical outcomes than a change score denoting minimal clinically important difference.
Patients who underwent primary anterior cervical decompression and fusion, cervical disk replacement, or laminectomy were included. The outcome measure was NDI. The anchor used to assess PASS achievement at six months was the response on the Global Rating Change: "Compared with preoperative, you feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or (5) much worse." It was converted to a dichotomous outcome variable (acceptable=response of 1 or 2, unacceptable=response of 3, 4, or 5) for analyses. The overall cohort and subgroups based on age (65 yr and below, above 65 yr), sex, myelopathy, and preoperative NDI (≤40, >40) were analyzed for the proportion of patients achieving PASS and the NDI cut-off using receiver operator curve.
Seventy-five patients (42 anterior cervical decompression and fusion, 23 cervical disc replacement, 10 laminectomy) were included. 79% of patients achieved PASS. Males, patients with age 65 years and below, preoperative NDI ≤40, and absence of myelopathy were more likely to achieve PASS. The receiver operator curve analysis revealed an Oswestry Disability Index cut-off of 21 to achieve PASS (area under the curve, AUC: 0.829, sensitivity: 81%, specificity: 80%). The subgroup analyses based on age, sex, myelopathy, and preoperative NDI revealed AUCs >0.7 and NDI threshold values consistent between 17 and 23.
With an AUC of 0.829, NDI showed an excellent discriminative ability. Patients with NDI ≤21 are expected to achieve PASS following degenerative cervical spine surgery.
对前瞻性收集的数据进行回顾性分析。
确定退行性颈椎手术后6个月达到患者可接受症状状态（PASS）的颈部功能障碍指数（NDI）临界值。
表示PASS的绝对评分可能比表示最小临床重要差异的变化评分更适合作为评估临床结果的指标。
纳入接受初次前路颈椎减压融合术、颈椎间盘置换术或椎板切除术的患者。结局指标为NDI。用于评估6个月时是否达到PASS的参照指标是全球评级变化的回答：“与术前相比，您感觉（1）好多了，（2）稍好一些，（3）一样，（4）稍差一些，或（5）差得多。” 为了进行分析，将其转换为二分结局变量（可接受=回答为1或2；不可接受=回答为3、4或5）。对整个队列以及根据年龄（65岁及以下、65岁以上）、性别、脊髓病和术前NDI（≤40、>40）划分的亚组分析达到PASS的患者比例以及使用受试者工作特征曲线确定NDI临界值。
共纳入75例患者（42例行前路颈椎减压融合术，23例行颈椎间盘置换术，10例行椎板切除术）。79%的患者达到PASS。男性、年龄65岁及以下的患者、术前NDI≤40且无脊髓病的患者更有可能达到PASS。受试者工作特征曲线分析显示，Oswestry功能障碍指数临界值为21时可达到PASS（曲线下面积，AUC：0.829，敏感性：81%，特异性：80%）。基于年龄、性别、脊髓病和术前NDI的亚组分析显示AUC>0.7，NDI阈值在17至23之间一致。
NDI的AUC为0.829，显示出出色的鉴别能力。预计NDI≤21的患者在退行性颈椎手术后可达到PASS。
