Satisfaction in Five Year Patient Reported Outcomes in Cervical Spondylotic Myelopathy: An Analysis of a Single Practice

Introduction: Evidence regarding long-term outcomes of surgical intervention in Cervical Spondylotic Myelopathy (CSM) is critical, as these factors correlate with patient reported outcome measures (PROMs), and thus are indicative of patient quality of life and play a role in physician reimbursement. The objective of this study is to evaluate patient specific factors that may be associated with long-term patient satisfaction.

Methods: A retrospective analysis of the quality outcomes database (QOD) following surgical intervention for CSM of a high volume private practice in the QOD Study Group was performed. Patient baseline characteristics, socioeconomic descriptors, and PROMs were collected after 12-month, 24-month, and 60-month periods following surgery. Satisfaction was measured using NASS Satisfaction. Satisfaction was defined as reporting NASS scores of 1 or 2.

Results: From the QOD, 33 patients with 12-month, 24-month, and 60-month follow-ups were identified. Of these, 19 underwent ACDF and 14 underwent PCF. 26 of 33 patients reported being satisfied with their surgical outcomes at 60 months. There was no difference in reported satisfaction by initial presentation and medical comorbidities, except unsatisfied patients had significantly higher rates of depression (p=0.02). Patients in the 3rd socioeconomic quartile were more likely to be unsatisfied than satisfied (p=0.01), whereas patients in the 4th socioeconomic quartile were more likely to be satisfied than unsatisfied (p=0.04). Unsatisfied patients had significantly higher Neck Disability Indexes (NDIs) at 12-month, 24-month, and 60-month periods than satisfied patients (p=0.01, p=0.02, p=0.01, respectively). Furthermore, unsatisfied patients had significantly lower modified Japanese Orthopaedic Association scale results (MJOAs) at 12-month and 24-month periods than satisfied patients (p=0.0001, p=0.01, respectively. Unsatisfied patients had significantly worse neck pain and arm pain on a visual analog scale (VAS) (p=0.05, p=0.02, respectively).

Conclusion : Notably, patients with less satisfaction were of significantly lower baseline SES and had higher rates of depression. As expected, unsatisfied patients reported significantly higher disability. Further studies should analyze SES in different practice settings as predictors of postoperative satisfaction. Further studies should investigate measures to support patients in lower SES quartiles.