The Association of Preoperative Duration of Symptoms With Clinical Outcomes and Minimal Clinically Important Difference Following Anterior Cervical Discectomy and Fusion

Abstract

Study Design: This was a retrospective cohort study. Objective: The purpose of this study is to examine whether the time duration from symptom onset to operative treatment is associated with postoperative clinical improvement after anterior cervical discectomy and fusion (ACDF). Summary of Background Data: There is a paucity of literature regarding the influence of preoperative symptom duration on patient-reported outcomes (PROs) following ACDF. Methods: Patients who underwent primary, single-level ACDF were retrospectively reviewed and stratified according to preoperative symptom duration (<12 and ≥12 mo). Demographic and perioperative characteristics were compared using χ2 analysis and linear regression. Subgroup mean scores were compared and achievement of minimal clinically important difference (MCID) was assessed for the Neck Disability Index (NDI), Visual Analogue Scale (VAS) neck pain, VAS arm pain, and 12-Item Short-Form Physical Component Score. Results: A total of 109 patients underwent primary, single-level ACDF: 68 had duration of symptoms (DOS) <12 months and 41 had a DOS ≥12 months. When comparing DOS subgroup preoperative PROs, there was no preoperative difference in NDI, VAS arm or neck pain, and 12-Item Short-Form Physical Component Score. In the postoperative period, there were no significant differences in the improvement of PROs throughout the 12-month timepoint. A significantly larger proportion of the <12 months DOS cohort achieved NDI MCID at the 3-month (66.1% vs. 43.8%, P=0.039) and 6-month (76.8% vs. 53.6%, P=0.030) postoperative period. Conclusions: Among the patient subgroups with <12 and ≥12 months DOS, there were no statistically significant differences observed in any of the measured PRO means at any timepoint. When assessing MCID, however, patients with shorter DOS (<12 mo) were observed to attain NDI MCID at the 3- and 6-month timepoints more often than patients with DOS ≥12 months. Our findings suggest that delayed surgical intervention may impair functional recovery to MCID in patients with degenerative cervical disease.

Impact of Prolonged Duration of Symptoms on Mental Health in Anterior Cervical Disectomy and Fusion Patients

“…Interestingly, however, Jenkins et al reported that patients with higher preoperative PHQ-9 scores actually achieved MCID in NDI at higher rates than those with lower preoperative depression scores. Considering the close relationship that has been demonstrated between disability and both mental health and duration of symptoms, 5,20 we surmised that duration of symptoms would be an important factor for postoperative mental health outcomes.…”

“…Previous studies in cervical spine patients have demonstrated notable associations between preoperative symptom severity and depressive symptoms. Jenkins et al 5 reported markedly poorer pain, disability, and physical function scores among patients with PHQ-9 scores of 5 or greater. In particular, diminished physical function or ambulatory ability has been tied to diminished mental health.…”

“…Furthermore, our study used a more detailed stratification of symptom duration than many previous analyses. 5,6 This methodological decision caused the number of patients in some groups to be limited, in particular those experiencing symptoms for more intermediate durations of time. This issue may have been exacerbated by somewhat limited survey response rates at the long-term follow-up.…”

“…Studies have suggested that patients with a shorter duration of symptoms before cervical spine surgery may have markedly greater postoperative improvement in radicular pain and minimum clinically important difference (MCID) achievement for disability than those with longer symptom durations. 4–6…”

“…Studies have suggested that patients with a shorter duration of symptoms before cervical spine surgery may have markedly greater postoperative improvement in radicular pain and minimum clinically important difference (MCID) achievement for disability than those with longer symptom durations. [4][5][6] Although these physical outcomes have been assessed, more than a third of those with degenerative pathology of the cervical spine may also experience depressed moods; therefore, patients' mental outcomes must also be considered in this context. 7,8 ACDF has been suggested to improve a patient's state of mental health, as assessed with the Patient Health Questionnaire-9 (PHQ-9).…”