Resident Physician UCSF Department of Neurosurgery San Francisco, California, United States
Disclosure(s):
Alexa Semonche, MD: No financial relationships to disclose
Introduction: Both cognitive impairment (CI) and pain catastrophizing are independently associated with worse surgical outcomes. We sought to characterize the prevalence of CI in patients with adult spinal deformity (ASD) correction. We further investigated relationships between CI and pre-operative patient reported outcome metrics (PROMs).
Methods: This is a prospective study enrolling patients undergoing evaluation for ASD correction at a single tertiary care center. Patients were assessed preoperatively using the Montreal Cognitive Assessment (MOCA), Pain Catastrophizing Scale (PCS), Scoliosis Research Society 22r (SRS-22r) and the Oswestry Disability Index (ODI). PCS, SRS-22r, and ODI responses were compared between patients with any degree of CI (MOCA < 26) and no CI (MOCA≥26) using student’s t-test and Pearson’s correlation analysis.
Results: Between 2017-2024, 257 patients were enrolled. Forty-seven (18.2%) patients were removed from analysis due to incomplete MOCA or PCS data, yielding a final study population of 210 patients. Of these, 123 patients (58.6%) had normal cognition and 87 (41.4%) had mild or moderate CI; none had severe CI. Patients with mild-moderate CI had greater mean total and component PCS scores (mean ± standard deviation for total PCS: 24.4±13.9 vs. 19.5±12.8, p=0.0098; Rumination: 9.0±5.2 vs 7.0±4.9, p=0.005; Magnification: 5.0±3.3 vs. 3.9±2.9, p=0.02; Helplessness: 10.4±6.7 vs. 8.6±6.1, p=0.046). Lower MOCA scores were significantly correlated with higher PCS scores (total score r=-0.26, p=0.0001; Rumination: -0.28, p< 0.001; Magnification: -0.23, p< 0.001; Helplessness: -0.22, p=0.001). Neither ODI or SRS-22r responses differed significantly between patients with or without CI. Lower MOCA scores were weakly correlated with higher SRS-22r satisfaction scores (r=-0.17, P=0.03), but lower SRS-22r mental health scores (r=0.20, P=0.005).
Conclusion : There was a high prevalence (41.4%) of CI in ASD patients. Patients with mild-moderate CI had more severe pain catastrophizing and this was reflected in all individual components of the PCS scale (Rumination, Magnification, Helplessness). SRS-22r and ODI survey responses did not significantly differ based on MOCA scores. These findings suggest CI and pain catastrophizing may contribute to pain perception in a way that is not captured by traditional PROMS in ASD patients. Understanding the prevalence and impact of CI on PROMs is important to improve patient selection and preoperative counseling.