Non-respondents do not bias outcome assessment after cervical spine surgery: a multicenter observational study from the Norwegian registry for spine surgery (NORspine)

Ingebrigtsen, Tor; Aune, Grethe; Karlsen, Martine Eriksen; Gulati, Sasha; Kolstad, Frode; Nygaard, Øystein P.; Thyrhaug, Anette Moltu

doi:10.1007/s00701-022-05453-x

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…However, a NORspine study showed no difference in outcomes between responders and non-responders [33]. We found no difference in RTW ratios between responders and non-responders in our study, which is consistent with previous studies indicating that non-responders do not bias evaluation of PROMs [7,14,15]. Even so, we do not know the exact reasons for non-respondence, and our results must be interpreted with this in mind.…”

Section: Limitationssupporting

confidence: 81%

Return to work after surgery for degenerative cervical myelopathy: a nationwide registry-based observational study

et al. 2023

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Background Few studies of high quality exist on return to work (RTW) rate after surgery for degenerative cervical myelopathy (DCM). This study aims to examine the RTW rate in patients undergoing surgery for DCM. Methods Nationwide prospectively collected data were obtained from the Norwegian Registry for Spine Surgery and the Norwegian Labour and Welfare Administration. The primary outcome was return to work, defined as being at work at a given time postoperatively without any medical income-compensation benefits. Secondary endpoints included the neck disability index (NDI) and quality of life measured by EuroQol-5D (EQ-5D). Results Among 439 patients operated for DCM between 2012 and 2018, 20% of the patients received a medical income-compensation benefit one year before surgery. This number increased steadily towards the operation at which timepoint 100% received benefits. By 12 months after surgery, 65% had returned to work. By 36 months, 75% had returned to work. Patients that returned to work were more likely to be non-smokers and to have a college education. They had less comorbidity, more were without benefit 1-year pre-surgery, and significantly more patients were employed at operation date. Average days of sick leave in the year before surgery were significantly less in the RTW group, and they had a significantly lower baseline NDI and EQ-5D All PROMs reached statistical significance at 12 months, in favor of the group that achieved RTW. Conclusion At 12 months following surgery, 65% had returned to work. At the end of the 36-month follow-up period, 75% had returned to work, 5% less than the working percentage in the beginning of the follow-up period. This study demonstrates that a large percentage of patients return to work after surgical treatment for DCM.

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Section: Limitationssupporting

confidence: 81%

Return to work after surgery for degenerative cervical myelopathy: a nationwide registry-based observational study

et al. 2023

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“…Previous reports from the Norwegian and Danish spine registries have found that data are missing at random, and outcomes after cervical and lumbar spine surgery are similar between respondents and nonrespondents. [62][63][64] Moreover, we found similar results in the complete case analyses and mixed-model analyses. Therefore, we do not consider that loss to follow-up introduced any attrition bias in this study.…”

Section: Limitationssupporting

confidence: 81%

Patient Characteristics Associated With Worsening of Neck Pain–Related Disability After Surgery for Degenerative Cervical Myelopathy: A Nationwide Study of 1508 Patients

Danielsen,

Ingebrigtsen,

Gulati

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Functional status, pain, and quality of life usually improve after surgery for degenerative cervical myelopathy (DCM), but a subset of patients report worsening. The objective was to define cutoff values for worsening on the Neck Disability Index (NDI) and identify prognostic factors associated with worsening of pain-related disability 12 months after DCM surgery. METHODS: In this prognostic study based on prospectively collected data from the Norwegian Registry for Spine Surgery, the NDI was the primary outcome. Receiver operating characteristics curve analyses were used to obtain cutoff values, using the global perceived effect scale as an external anchor. Univariable and multivariable analyses were performed using mixed logistic regression to evaluate the relationship between potential prognostic factors and the NDI. RESULTS: Among the 1508 patients undergoing surgery for myelopathy, 1248 (82.7%) were followed for either 3 or 12 months. Of these, 317 (25.4%) were classified to belong to the worsening group according to the mean NDI percentage change cutoff of 3.3. Multivariable analyses showed that smoking (odds ratio [OR] 3.4: 95% CI 1.2-9.5: P < .001), low educational level (OR 2.5: 95% CI 1.0-6.5: P < .001), and American Society of Anesthesiologists grade >II (OR 2.2: 95% CI 0.7-5.6: P = .004) were associated with worsening. Patients with more severe neck pain (OR 0.8: 95% CI 0.7-1.0: P = .003) and arm pain (OR 0.8: 95% CI 0.7-1.0; P = .007) at baseline were less likely to report worsening. CONCLUSION: We defined a cutoff value of 3.3 for worsening after DCM surgery using the mean NDI percentage change. The independent prognostic factors associated with worsening of pain-related disability were smoking, low educational level, and American Society of Anesthesiologists grade >II. Patients with more severe neck and arm pain at baseline were less likely to report worsening at 12 months.

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Section: Discussionmentioning

confidence: 99%

“…Loss to follow-up is a concern, but previous NORspine studies on degenerative lumbar and cervical spine surgery have shown no differences in outcomes between responders and nonresponders. 28,29 Because of the high proportion of patients with mild myelopathy and short duration of symptoms in our study, the generalizability of the results across other patient populations with more severe and chronic long-term preoperative symptoms is a concern. Our study is, however, a cohort from a national registry and represents consecutive patients from everyday practice.…”

Section: Figure Global Perceived Effectmentioning

confidence: 99%

Long-Term Results After Surgery for Degenerative Cervical Myelopathy

Johansen,

Holmberg,

Danielsen

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: Degenerative cervical myelopathy (DCM) is a frequent cause of spinal cord dysfunction, and surgical treatment is considered safe and effective. Long-term results after surgery are limited. This study investigated long-term clinical outcomes through data from the Norwegian registry for spine surgery. METHODS: Patients operated at the university hospitals serving Central and Northern Norway were approached for long-term follow-up after 3 to 8 years. The primary outcome was change in the Neck Disability Index, and the secondary outcomes were changes in the European Myelopathy Scale score, quality of life (EuroQoL EQ-5D); numeric rating scales (NRS) for headache, neck pain, and arm pain; and perceived benefit of surgery assessed by the Global Perceived Effect scale from 1 year to long-term follow-up. RESULTS: We included 144 patients operated between January 2013 and June 2018. In total, 123 participants (85.4%) provided patient-reported outcome measures (PROMs) at long-term follow-up. There was no significant change in PROMs from 1 year to long-term follow-up, including Neck Disability Index (mean 1.0, 95% CI −2.1-4.1, P = .53), European Myelopathy Scale score (mean −0.3, 95% CI −0.7-0.1, P = .09), EQ-5D index score (mean −0.02, 95% CI −0.09-0.05, P = .51), NRS neck pain (mean 0.3 95% CI −0.2-0.9, P = .22), NRS arm pain (mean −0.1, 95% CI −0.8-0.5, P = .70), and NRS headache (mean 0.4, 95% CI −0.1-0.9, P = .11). According to Global Perceived Effect assessments, 106/121 patients (87.6%) reported to be stable or improved (“complete recovery,” “much better,” “slightly better,” or “unchanged”) at long-term follow-up compared with 88.1% at 1 year. Dichotomizing the outcome data based on severity of DCM did not demonstrate significant changes either. CONCLUSION: Long-term follow-up of patients undergoing surgery for DCM demonstrates persistence of statistically significant and clinically meaningful improvement across a wide range of PROMs.

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Non-respondents do not bias outcome assessment after cervical spine surgery: a multicenter observational study from the Norwegian registry for spine surgery (NORspine)

Cited by 6 publications

References 29 publications

Return to work after surgery for degenerative cervical myelopathy: a nationwide registry-based observational study

Return to work after surgery for degenerative cervical myelopathy: a nationwide registry-based observational study

Patient Characteristics Associated With Worsening of Neck Pain–Related Disability After Surgery for Degenerative Cervical Myelopathy: A Nationwide Study of 1508 Patients

Long-Term Results After Surgery for Degenerative Cervical Myelopathy

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