Agarwal Nitin, Bisson Erica F, Bydon Mohamad, Asher Anthony L, Chan Andrew K, Wang Michael Y, Haid Regis W, Knightly John J, Gottfried Oren N, Shaffrey Christopher I, Virk Michael S, Shaffrey Mark E, Park Paul, Foley Kevin T, Coric Domagoj, Upadhyaya Cheerag D, Potts Eric A, Tumialán Luis M, Fu Kai-Ming G, Lavadi Raj Swaroop, Johnson Sarah E, Chou Dean, Mummaneni Praveen V
1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh.
2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh.
J Neurosurg Spine. 2025 May 30;43(2):170-180. doi: 10.3171/2025.2.SPINE231237. Print 2025 Aug 1.
Chronic spinal degenerative diseases have been associated with reduced quality of life and dependency on others for personal needs and care. The change between preoperative and postoperative care dependency has yet to be explored in patients with cervical spondylotic myelopathy (CSM). In this retrospective study of a prospectively collected database, the authors evaluated the return to independence in performing self-care following surgical intervention for CSM.
The CSM dataset of the Quality Outcomes Database (QOD) Spine CORe study group was queried. Care dependency was assessed using the personal care component of the Neck Disability Index (NDI) questionnaire, having an ordinal scale from 0 to 5, with 5 representing the inability to independently perform activities of daily living. Numeric rating scale (NRS) scores for arm pain and neck pain were recorded at a 24-months postoperative follow-up. Multivariable logistic regression analyses were performed to identify baseline risk factors for an inability to care for oneself and the symptoms leading to care dependency at 24 months postoperatively. Satisfaction with surgery was measured using the 4-point North American Spine Society (NASS) index.
Of the 1137 patients with CSM and baseline personal care scores, 167 (14.7%) were care dependent at baseline (NDI personal care score ≥ 3). Patients with care dependency at baseline were predominantly Medicare beneficiaries and had a high school or lower level of education. Long-term follow-up rates for this study were 82.5% for NDI, 84.8% for patient satisfaction with surgery, 82.4% for NRS arm pain, and 81.8% for NRS neck pain. Of the care-dependent patients, more than 80% became independently able to care for themselves by the 24-month follow-up. Patients with resolved care dependency at 24 months had demonstrated lower baseline NDI and NRS neck pain scores (p < 0.01 for both). Neck pain was significantly associated with care dependency at 24 months' follow-up (p < 0.01). Patients who reported improvement in their ability to care for themselves noted higher postoperative satisfaction (NASS score 1-2) at the 3-month (89.4% vs 80.2%, p < 0.01) and 24-month (88.2% vs 67.4%, p < 0.01) follow-ups.
Fifteen percent of patients with CSM depended on others for care preoperatively. After surgery to treat CSM, 81.8% of those who had depended on others for care became independent. Patients with improvements in care dependency noted higher postoperative satisfaction at the 3-month and 24-month follow-ups. Patients with resolved care dependency on long-term follow-up had lower NDI and NRS neck pain scores at baseline. Surgery had a significant impact on patients' attainment of independence.
慢性脊柱退行性疾病与生活质量下降以及在个人需求和护理方面对他人的依赖有关。颈椎脊髓病（CSM）患者术前和术后护理依赖的变化尚未得到探讨。在这项对前瞻性收集数据库的回顾性研究中，作者评估了CSM手术干预后自我护理恢复独立的情况。
查询了质量结果数据库（QOD）脊柱核心研究组的CSM数据集。使用颈部残疾指数（NDI）问卷的个人护理部分评估护理依赖程度，其序数范围为0至5，5表示无法独立进行日常生活活动。在术后24个月的随访中记录手臂疼痛和颈部疼痛的数字评分量表（NRS）得分。进行多变量逻辑回归分析，以确定术后24个月无法自理的基线风险因素以及导致护理依赖的症状。使用4分制北美脊柱协会（NASS）指数测量对手术的满意度。
在1137例有CSM和基线个人护理评分的患者中，167例（14.7%）在基线时存在护理依赖（NDI个人护理评分≥3）。基线时存在护理依赖的患者主要是医疗保险受益人，且教育程度为高中或更低。本研究的长期随访率为：NDI为82.5%，患者对手术的满意度为84.8%，NRS手臂疼痛为82.4%，NRS颈部疼痛为81.8%。在有护理依赖的患者中，超过80%在24个月随访时能够独立自理。术后24个月护理依赖得到解决的患者基线NDI和NRS颈部疼痛评分较低（两者均p<0.01）。在24个月的随访中，颈部疼痛与护理依赖显著相关（p<0.01）。报告自理能力有所改善的患者在3个月（89.4%对80.2%，p<0.01）和24个月（88.2%对67.4%，p<0.01）随访时对手术的满意度更高。
15%的CSM患者术前依赖他人护理。在接受治疗CSM的手术后，81.8%之前依赖他人护理的患者变得独立。护理依赖得到改善的患者在3个月和24个月随访时对手术的满意度更高。长期随访中护理依赖得到解决的患者基线NDI和NRS颈部疼痛评分较低。手术对患者实现独立有显著影响。
