Patel Madhav R, Jacob Kevin C, Chavez Frank A, Parsons Alexander W, Vanjani Nisheka N, Pawlowski Hanna, Prabhu Michael C, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Asian Spine J. 2023 Jun;17(3):500-510. doi: 10.31616/asj.2022.0027. Epub 2023 May 22.
Retrospective cohort.
To assess preoperative arm pain severity influence on postoperative patient-reported outcomes measures (PROMs) and minimal clinically important difference (MCID) achievement following single-level anterior cervical discectomy and fusion (ACDF).
There is evidence that preoperative symptom severity can affect postoperative outcomes. Few have evaluated this association between preoperative arm pain severity and postoperative PROMs and MCID achievement following ACDF.
Individuals undergoing single-level ACDF were identified. Patients were grouped by preoperative Visual Analog Scale (VAS) arm ≤8 vs. >8. PROMs collected preoperatively and postoperatively included VAS-arm/VAS-neck/Neck Disability Index (NDI)/12-item Short Form (SF-12) Physical Composite Score (PCS)/SF-12 mental composite score (MCS)/Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF). Demographics, PROMs, and MCID rates were compared between cohorts.
A total of 128 patients were included. The VAS arm ≤8 cohort significantly improved for all PROMs excepting VAS arm at 1-year/2-years, SF-12 MCS at 12-weeks/1-year/2-years, and SF-12 PCS/PROMIS-PF at 6-weeks, only (p ≤0.021, all). The VAS arm >8 cohort significantly improved for VAS neck at all timepoints, VAS arm from 6-weeks to 1-year, NDI from 6-weeks to 6-months, and SF-12 MCS/PROMIS-PF at 6-months (p ≤0.038, all). Postoperatively, the VAS arm >8 cohort had higher VAS-neck (6 weeks/6 months), VAS-arm (12 weeks/6 months), NDI (6 weeks/6 months), lower SF-12 MCS (6 weeks/6 months), SF-12 PCS (6 months), and PROMISPF (12 weeks/6 months) (p ≤0.038, all). MCID achievement rates were higher among the VAS arm >8 cohort for the VAS-arm at 6-weeks/12-weeks/1-year/overall and NDI at 2 years (p ≤0.038, all).
Significance in PROM score differences between VAS arm ≤8 vs. >8 generally dissipated at the 1-year and 2-year timepoint, although higher preoperative arm pain patients suffered from worse pain, disability, and mental/physical function scores. Furthermore, clinically meaningful rates of improvement were similar throughout the vast majority of timepoints for all PROMs studied.
回顾性队列研究。
评估单节段颈椎前路椎间盘切除融合术（ACDF）术前手臂疼痛严重程度对术后患者报告结局指标（PROMs）及最小临床重要差异（MCID）达成情况的影响。
有证据表明术前症状严重程度会影响术后结局。很少有研究评估ACDF术前手臂疼痛严重程度与术后PROMs及MCID达成情况之间的这种关联。
纳入接受单节段ACDF的患者。根据术前视觉模拟评分（VAS）手臂疼痛≤8分与>8分将患者分组。术前及术后收集的PROMs包括VAS手臂/VAS颈部/颈部残疾指数（NDI）/12项简明健康调查（SF - 12）身体综合评分（PCS）/SF - 12心理综合评分（MCS）/患者报告结局测量信息系统身体功能（PROMIS - PF）。比较两组间的人口统计学、PROMs及MCID发生率。
共纳入128例患者。VAS手臂≤8分组除了在1年/2年时的VAS手臂、12周/1年/2年时的SF - 12 MCS以及仅在6周时的SF - 12 PCS/PROMIS - PF外，所有PROMs均有显著改善（p均≤0.021）。VAS手臂>8分组在所有时间点的VAS颈部、6周至1年的VAS手臂、6周至6个月的NDI以及6个月时的SF - 12 MCS/PROMIS - PF均有显著改善（p均≤0.038）。术后，VAS手臂>8分组在6周/六个月时的VAS颈部、12周/六个月时的VAS手臂、6周/六个月时的NDI更高，而在6周/六个月时的SF - 12 MCS、六个月时的SF - 12 PCS以及12周/六个月时的PROMIS - PF更低（p均≤0.038）。VAS手臂>8分组在6周/12周/1年/总体的VAS手臂以及2年时的NDI的MCID达成率更高（p均≤0.038）。
VAS手臂≤8分与>8分之间PROM评分差异的显著性在1年和2年时间点通常消失，尽管术前手臂疼痛较重的患者疼痛、残疾及心理/身体功能评分更差。此外，在研究的所有PROMs的绝大多数时间点，临床上有意义的改善率相似。
