Risk Factors Associated With Failure to Reach Minimal Clinically Important Difference in Patient-Reported Outcomes Following Anterior Cervical Discectomy and Fusion

Abstract

Background: The minimum clinically importance difference (MCID) represents a threshold for improvements in patient-reported outcomes (PROs) that patients deem important. No previous study has comprehensively examined risk factors for failure to achieve MCID after anterior cervical discectomy and fusion (ACDF) procedures for radiculopathic symptomatology. The purpose of this study is to determine risk factors for failure to reach MCID for Neck Disability Index (NDI), Visual Analog Scale (VAS) neck pain, and VAS arm pain in patients undergoing 1-or 2-level ACDF procedures. Methods: A surgical registry of patients who underwent primary, 1-or 2-level ACDF from 2014 to 2016 was reviewed. Rates of MCID achievement for NDI, VAS neck pain, and VAS arm pain at final follow-up were calculated based on published MCID values. Patients were then categorized into demographic and procedural categories. Bivariate regression was used to test for association of demographic and procedural characteristics with failure to reach MCID for each PRO. The final multivariate model including all demographic and procedural categories as controls was created using backward stepwise regression. Results: Eighty-three, 84, and 77 patients were included in the analysis for VAS neck, VAS arm, and NDI, respectively. Rates of MCID achievement for VAS neck, VAS arm, and NDI were 55.4%, 36.9%, and 76.6%, respectively. On bivariate analysis, patients with Charlson Comorbidity Index (CCI) ! 2 were less likely to achieve MCID for NDI than patients with CCI , 2 (P ¼ .025). On multivariate analysis, CCI ! 2 (P ¼ .025) was further associated with failure to reach MCID for NDI. Conclusions: The results of this study suggest that the majority of patients do not reach MCID for arm pain. Additionally, higher comorbidity burden as evidenced by higher CCI scores is a negative predictive factor for the achievement of MCID in neck disability following ACDF.

Anterior surgical treatment for cervical degenerative radiculopathy: a prediction model for non-success

“…The present study could not find that high age was a predictor of non-success in neither neck disability nor arm pain. This is supported by other multivariate studies [ 2 , 29 , 34 ]. Further, both comorbidity and ASA level only came out as significant predictors for non-success in the present univariate analyses but not in the final multivariate analysis.…”

Choose Wisely: Surgical Selection of Candidates for Outpatient Anterior Cervical Surgery Based on Early Complications Among Inpatients

“…Khalid et al also found that upper cervical spine surgeries were at increased risk for postoperative dysphagia 31 . Longer operative times, as previously shown by Narain et al 27 , were significantly associated with a postoperative complication. ENT surgeon-assisted cases were more likely to have a postoperative complication.…”

Comorbidity Influence on Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

“…10 Moreover, investigators have reported that higher comorbidity burdens act as negative predictive factors for achieving an MCID for disability and physical function scores among ACDF and lumbar decompressions patients, respectively. 5,11 While numerous studies report on how multiple comorbidities increase the risk of complications, 12,13 few focus on the cervical spine and even fewer investigate the effects on physical function. Although traditionally more attention has been placed on outcomes in the lumbar spine, cervical spine conditions have distinct etiologies and symptoms, such as myelopathic or radicular arm pain, that can translate into differences in outcomes.…”