Medical Student Loyola University Chicago Stritch School of Medicine
Disclosure(s):
Benjamin M. Varieur, BS: No financial relationships to disclose
Introduction: Laminoplasty is a common surgical treatment for cervical myelopathy. Collars are often prescribed or recommended after cervical surgery to theoretically aid healing and minimize pain, however, their use may be detrimental. The purpose of this study was to evaluate patient-reported outcome measures (PROMs), including mental health measures, in patients with and without cervical collar use following laminoplasty.
Methods: All adult patients undergoing cervical laminoplasty between January 2017 and January 2021 were identified. Medical charts were reviewed to obtain demographic and surgical characteristics and PROMs. Patients were stratified based on no cervical collar prescription (NC) and prescribed collar use at all times (AAT) postoperatively. PROMs were collected preoperatively and ≥ 1 month postoperatively and included PROMIS Global Health Short Form (SF) Physical, PROMIS Global Health SF Mental, PROMIS SF 4a Anxiety, PROMIS SF 4a Depression, PROMIS Physical Function SF 10a, and PROMIS Pain Intensity SF 3a domains. Minimum clinically important difference (MCID) was calculated according to distribution-based methods corresponding to one-half of the standard deviation for each measure.
Results: Ninety-three patients met preliminary inclusion criteria; 34 patients (36.6%) in the NC group and 59 (63.4%) AAT. Median patient age was 67 years (IQR 59-72) and 59 (63.4%) were male. There were no significant differences in demographic or surgical characteristics between NC and AAT groups. Across the entire cohort, there were significant improvements in preoperative to postoperative PROMIS Physical [39.8 (34.9-44.9) vs. 39.8 (37.4-44.9), P = 0.022], PROMIS Mental [43.5 (38.8-50.8) vs. 45.8 (41.1-53.3), P = 0.008], Physical Function [37.2 (32.7-40.1) vs. 37.8 (33.5-42.6), P = 0.026], and Pain Intensity [54.5 (IQR 49.4-57.5) vs. 50.8 (43.5-57.5), P = 0.003] scores. NC patients were more likely to achieve MCID in depression scores than patients in the AAT group [13 (44.8%) vs. 9 (20.0%), OR = 3.2 (95% CI 1.0-10.4), P = 0.036]. There were no significant differences in MCID achievement between NC and AAT groups among other PROMs domains.
Conclusion : These findings indicate that unrestricted range of motion following cervical laminoplasty may improve MCID and may have an even greater benefit on depression affect.