Abstract
INTRODUCTION:There is limited data on the outcomes regarding the effect of upper instrumented vertebrae (UIV) selection in patients with cervical spondylotic myelopathy (CSM).METHODS:This was an analysis of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort which included adult patients who were diagnosed with primary CSM undergoing elective surgery. Patient-reported outcomes including VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction were collected at baseline and 24 months.RESULTS:Of the 239 patients with CSM who underwent PCF, 48 (20.1%) had UIV of C2 and 191 (79.9%) had UIV of C3/below. The 24-month follow-up rate was 87.4% for patient-reported outcomes. At baseline, C2 group had a higher frequency of motor deficit (83.3% vs 68.1%, p = 0.04) compared to the C3/below group; otherwise, there was no difference in pain, function, and quality of life. C2 group had greater number of treated levels (6.1 ± 2.0 vs 4.5 ± 1.3, p < 0.01) compared to the C3/below group. At 24-month follow-up, the two groups achieved similar rates of satisfaction and MCID for pain, disability, myelopathy, and quality of life (all p > 0.05) postoperatively.CONCLUSIONS:Although the C2 group had greater number of treated levels compared to the C3/below group, the two cohorts had overall similar baseline characteristics and achieved similar MCID rates of the measured outcomes. The results of this study suggest that UIV of C2 may not have appreciable benefit over subaxial UIV in patient-reported outcomes.