Impact of Preoperative Symptom Duration on Patient-Reported Outcomes Following Cervical Disc Replacement for Cervical Radiculopathy

Eric Mai; Eric Kim; Austin Kaidi; Tejas Subramanian; Chad Z Simon; Tomoyuki Asada; Cole Kwas; Joshua Zhang; Kasra Araghi; Nishtha Singh; Olivia Tuma; Maximilian Korsun; Myles Allen; Annika Heuer; Evan D Sheha; James Dowdell; Russel C Huang; Todd J Albert; Sheeraz A Qureshi; Sravisht Iyer

doi:10.1097/BRS.0000000000005020

Impact of Preoperative Symptom Duration on Patient-Reported Outcomes Following Cervical Disc Replacement for Cervical Radiculopathy

Spine (Phila Pa 1976). 2024 Apr 29. doi: 10.1097/BRS.0000000000005020. Online ahead of print.

Authors

Eric Mai^{1

2}, Eric Kim¹, Austin Kaidi¹, Tejas Subramanian^{1

2}, Chad Z Simon¹, Tomoyuki Asada¹, Cole Kwas¹, Joshua Zhang¹, Kasra Araghi¹, Nishtha Singh¹, Olivia Tuma¹, Maximilian Korsun¹, Myles Allen¹, Annika Heuer¹, Evan D Sheha¹, James Dowdell¹, Russel C Huang¹, Todd J Albert¹, Sheeraz A Qureshi¹, Sravisht Iyer¹

Affiliations

¹ Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
² Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA.

PMID: 38679871
DOI: 10.1097/BRS.0000000000005020

Abstract

Study design: Retrospective review of prospectively collected data.

Objective: To determine the impact of preoperative symptom duration on postoperative functional outcomes following cervical disc replacement (CDR) for radiculopathy.

Summary of background data: CDR has emerged as a reliable and efficacious treatment option for degenerative cervical spine pathologies. The relationship between preoperative symptom duration and outcomes following CDR is not well established.

Methods: Patients with radiculopathy without myelopathy who underwent primary 1- or 2-level CDRs were included and divided into shorter (<6 mo) and prolonged (≥6 mo) cohorts based on preoperative symptom duration. Patient-reported outcome measures (PROMs) included Neck Disability Index (NDI), Visual Analog Scale (VAS) Neck and Arm. Change in PROM scores and minimal clinically important difference (MCID) rates were calculated. Analyses were conducted on the early (within 3 mo) and late (6 mo-2 y) postoperative periods.

Results: A total of 201 patients (43.6±8.7 y, 33.3% female) were included. In both early and late postoperative periods, the shorter preoperative symptom duration cohort experienced significantly greater change from preoperative PROM scores compared to the prolonged symptom duration cohort for NDI, VAS-Neck, and VAS-Arm. The shorter symptom duration cohort achieved MCID in the early postoperative period at a significantly higher rate for NDI (78.9% vs. 54.9%, P=0.001), VAS-Neck (87.0% vs. 56.0%, P<0.001), and VAS-Arm (90.5% vs. 70.7%, P=0.002). Prolonged preoperative symptom duration (≥6 mo) was identified as an independent risk factor for failure to achieve MCID at the latest timepoint for NDI (OR: 2.9, 95% CI: 1.2-6.9, P=0.016), VAS-Neck (OR: 9.8, 95% CI: 3.7-26.0, P<0.001), and VAS-Arm (OR: 7.5, 95% CI: 2.5-22.5, P<0.001).

Conclusions: Our study demonstrates improved patient-reported outcomes for those with shorter preoperative symptom duration undergoing CDR for radiculopathy, suggesting delayed surgical intervention may result in poorer outcomes and greater postoperative disability.

Level of evidence: III.