How Closely Are Outcome Questionnaires Correlated to Patient Satisfaction After Cervical Spine Surgery for Myelopathy?

Introduction: Patient-reported outcomes (PROs) have become the standard means to measure surgical outcomes. Insurers and policy makers are utilizing PROs to assess value of care. Multiple PROs exist and measure different aspects of a patient’s condition. For cervical myelopathy, it is unclear which outcomes best reflect patient satisfaction. This investigation evaluates which outcome questionnaires best correlate with patient satisfaction in patients treated for cervical myelopathy.

Methods: The Quality Outcomes Database (QOD), a prospectively collected multi-institutional database, was used to retrospectively analyze patients undergoing surgery for cervical myelopathy. The North American Spine Society (NASS) satisfaction index, Neck Disability Index (NDI), numerical rating scale for neck pain (NP-NRS) and arm pain (AP-NRS), EuroQoL-5-Dimension (EQ-5D), and modified Japanese Orthopedic Association (mJOA) survey were evaluated.

Results: 1141 patients were diagnosed with myelopathy, of which 1107 (98%) also had neck pain and 379 (33%) had radiculopathy. At 3-month follow-up, NASS was positively correlated with NP-NRS (R = 0.298), AP-NRS (R = 0.315), and NDI (R = 0.362), and negatively correlated with EQ-5D (R = -0.376) and mJOA (R = -0.287), all p < 0.001. At 12-month follow-up, NASS was positively correlated with NP-NRS (R = 0.442), AP-NRS (R = 0.384), and NDI (R = 0.459), and negatively correlated with EQ-5D (R = -0.397) and mJOA (R = -0.363), all p < 0.001. At 24-month follow-up, NASS was positively correlated with NP-NRS (R = 0.490), AP-NRS (R = 0.358), and NDI (R = 0.491), and negatively correlated with EQ-5D (R = -0.437) and mJOA (R = -0.378), all p < 0.001.

Conclusion : Neck pain was highly prevalent in myelopathy patients. Improvement in neck pain–associated disability was the most prominent factor for patients rather than improvement in myelopathy. As commercial payers examine novel remuneration strategies, a thoughtful analysis of outcomes measurements will have increasing relevance.