Establishing Maximal Medical Improvement Following Anterior Cervical Discectomy and Fusion

Transcription

1 Establishing Maximal Medical Improvement Following Anterior Cervical Discectomy and Fusion Benjamin Khechen, BA1 ; Dil V. Patel, BS1; Anirudh K. Gowd, BS1; Mundeep S. Bawa, BA1; Harmeet S. Bawa, BA1; Jordan A. Guntin, BS1; Sailee S. Karmarkar, BS1; Joseph N. Liu, MD1; Kern Singh, MD1,2 1 2 Department of Orthopaedic Surgery, Rush University Medical Center Professor, Co-Director of the Minimally Invasive Spine Institute at Rush University Medical Center; Founder and President, Minimally Invasive Spine Study Group

2 Disclosures Benjamin Khechen, Dil V. Patel, Anirudh K. Gowd, Mundeep S. Bawa, Harmeet S. Bawa, Jordan A. Guntin, Sailee S. Karmarkar, Joseph N. Liu Nothing to disclose Kern Singh, MD Board Membership Vital 5 LLC, Avaz Surgical LLC Consultant Depuy, Zimmer, Stryker Royalties Zimmer, Stryker, Pioneer, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, Slack Publishing Grants Cervical Spine Research Society

3 Background and Purpose The identification of a time point at which patients reach maximal medical improvement (MMI) allows providers to understand postoperative requirements and manage expectations of surgical patients To identify the time point at which patients undergoing primary, single-level anterior cervical discectomy and fusion (ACDF) can be considered to have reached MMI.

4 Methodology Retrospective review of a prospectively-maintained database 69 patients that underwent a primary, single-level ACDF for degenerative pathology from 2014 to 2017

5 Methodology Variables Analyzed Patient demographics Patient-Reported Outcomes (PROs) Neck Disability Index (NDI) Statistical Analyses Pearson chi-square Multivariate linear regression Distribution-based MCID Nonparametric receiver operating characteristic (ROC) curve Kaplan-Meier survival analysis Cox regression

6 Results Patient demographics and baseline characteristics

7 Results NDI improvements in ACDF patients ranging from preoperative to 12-months postoperatively

8 Results Over 95% of patients reach MCID for NDI at 6 months

9 Discussion 95.7% achieved MCID by 6 months, allowing MMI to be established at this point.

10 Limitations Incomplete survey data beyond 1-year limited analysis of detecting further improvement in NDI Other patient-reported outcomes, such as pain scores, were not evaluated during this investigation

11 Conclusions The majority of patients (62.7%) achieved MCID by 6-weeks As over 95% of patients achieved MCID by 6-months postoperatively, this time point was determined to represent MMI Future outcome reporting in patients undergoing ACDF should include follow-up to 6 months postoperatively

12 References Segal DN, Wilson JM, Staley C, Yoon TS. Outpatient and Inpatient Single-Level Cervical Total Disc Replacement: A Comparison of 30-day Outcomes. Spine. 2018; Inoue T, Ohara Y, Niiro T, Endo T, Tominaga T, Mizuno JI. Cervical Periosteal Chondroma Causing Spinal Cord or Nerve Compression: 2 Case Reports and Literature Review. World Neurosurg. 2018;114: Harrison DE, Oakley PA, Betz JW. Anterior head translation following cervical fusion-a probable cause of post-surgical pain and impairment: a CBP case report. J Phys Ther Sci. 2018;30(2): Wong KE, Chang PS, Monasky MS, Samuelson RM. Traumatic spondyloptosis of the cervical spine: A case report and discussion of worldwide treatment trends. Surg Neurol Int. 2017;8:89. Lu VM, Zhang L, Scherman DB, Rao PJ, Mobbs RJ, Phan K. Treating multi-level cervical disc disease with hybrid surgery compared to anterior cervical discectomy and fusion: a systematic review and meta-analysis. Eur Spine J. 2017;26(2): Somani S, Di capua J, Kim JS, et al. Comparing National Inpatient Sample and National Surgical Quality Improvement Program: An Independent Risk Factor Analysis for Risk Stratification in Anterior Cervical Discectomy and Fusion. Spine. 2017;42(8): Bohl DD, Ahn J, Collins M, et al. Functional Capacity Evaluation Following Spinal Fusion Surgery. Spine. 2016;41(13): Lukasiewicz AM, Basques BA, Bohl DD, Webb ML, Samuel AM, Grauer JN. Myelopathy is associated with increased all-cause morbidity and mortality following anterior cervical discectomy and fusion: a study of 5256 patients in American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Spine. 2015;40(7): Buerba RA, Giles E, Webb ML, Fu MC, Gvozdyev B, Grauer JN. Increased risk of complications after anterior cervical discectomy and fusion in the elderly: an analysis of 6253 patients in the American College of Surgeons National Surgical Quality Improvement Program database. Spine. 2014;39(25): Seicean A, Alan N, Seicean S, et al. Impact of increased body mass index on outcomes of elective spinal surgery. Spine. 2014;39(18): Lu Y, Qureshi SA. Cost-effective studies in spine surgeries: a narrative review. Spine J. 2014;14(11): Fehlings MG, Barry S, Kopjar B, et al. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine. 2013;38(26):

13 THANK YOU! Contact us about questions and membership opportunities missg.org (312)