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Spine Summit

Socioeconomic

Is there Regional Variation across the United States in outcomes for patients undergoing a 1, 2, or 3-level ACDF for CSM? – A Quality Outcomes Database study

Friday, February 21, 2025

    Presenting Author(s)

  • Michael E. Tawil, BS

    Medical Student
    University of California, San Francisco
    San Francisco, CA, US

Disclosure(s):
Michael E. Tawil, BS: No financial relationships to disclose


Introduction: In the United States, there is regional variations in the outcomes of spine surgery for various pathologies. Here we study the regional variation in patients who underwent anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM).

Methods: We queried the Quality Outcomes Database from the 14 highest enrolling sites for patients diagnosed with CSM and underwent 1, 2, or 3-level ACDF. Our primary outcome measure to assess regional variation was the minimal clinically important difference (MCID) in patient-reported outcomes (PROs), including neck disability index (NDI) and EuroQol 5 Dimension 5 (EQ-5D) scores at baseline and 24 months postoperatively.

Results: Among the 1141 patients that underwent surgery for CSM, 396 patients underwent a 1, 2, or 3 level ACDF with baseline and 24-month PROs available. The number of patients per region included: Northeast (n = 61), South (n = 154), Midwest (n = 114), and West (n = 67).

For the entire cohort, there were no statistical differences in regional variations for the percentage of patients who achieved MCID for NDI (p=0.121) or EQ-5D (p=0.257).

In subanalysis of patients who underwent 1-level ACDFs (n = 170), the Midwest had the highest percentage of patients who achieved MCID for NDI (83.3%), followed by the Northeast with 23 patients (76.7%), the West with 14 patients (53.8%), and the South with 32 patients (53.3%) (p=0.002). No difference was found in the percentage of patients achieving MCID for EQ-5D (p=0.331). In multivariate regression, region was not predictive of achieving MCID for NDI (p > 0.05).

In similar subanalyses in patients who underwent 2- level, or 3-level ACDF there were no significant regional variations in MCID for NDI or EQ-5D.

Conclusion : In the United States, there is no difference in outcomes among regions for patients undergoing a 1, 2 or 3 level ACDF.