Abstract
Prospective.
To identify factors predicting the most (and least) satisfaction following surgery for cervical spondylotic myelopathy (CSM).
Patient satisfaction affects long-term outcomes after surgery but the preoperative factors that influence postoperative satisfaction have not been well studied in patients with CSM.
We conducted a prospective analysis of data from the Quality Outcomes Database (QOD) CSM registry cohort. Baseline and surgical characteristics were compared for patients with CSM reporting the most [North American Spine Society Satisfaction Score (NASS) 1] and least (NASS 4) satisfaction 24 months postoperatively. A multivariable logistic regression model was constructed using backward stepwise elimination to determine significant predictors of most versus least satisfaction. Twenty-four-month patient-reported outcomes (PROs) were compared.
Overall, 1,141 patients were prospectively enrolled with 948 (83.1%) reaching 24-month follow-up. Of these, 699 met prespecified inclusion criteria: 610 (87.3%) were most satisfied and 89 (12.7%) were least satisfied. Though there were mean improvements in all 24-month PROs for the most satisfied cohort (P<0.001), there were no significant improvements in 24-month PROs for the least satisfied cohort (P>0.05). Using multivariable logistic regression modeling, a preoperative symptom of upper extremity weakness (OR=2.5, P=0.003), subjective myelopathy (OR=2.0, P=0.04), absence of numbness complaints (OR=2.2, P=0.003), symptom duration under one year (OR=1.6, P=0.047), Caucasian race (OR=2.3, P=0.001), participation in activities outside of the home (OR=2.0, P=0.04), anterior approach (OR=2.3, P=0.001), and higher baseline quality of life (OR=4.0, P=0.01) were predictive of the most satisfaction.
Compared to the least satisfied, those most satisfied following surgery for CSM more often had a preoperative symptom of arm weakness, subjective myelopathy, the absence of numbness complaints, symptom duration under one year, higher baseline quality of life, and participation in activities outside of the home. Sociodemographically, Caucasian race was associated with the most satisfaction. Compared with a posterior approach, an anterior approach was associated with the most satisfaction.