Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients with Cervical Spondylotic Myelopathy: A Quality Outcomes Database (QOD) Study

Introduction: Patient education level has been suggested to correlate with health literacy and disease perception as well as socioeconomic status (SES) and access to health care. The association of educational level with disease severity has yet to be described in patients with cervical spondylotic myelopathy (CSM).

Methods: The CSM dataset of the Quality Outcomes Database (QOD) was utilized in this study to identify patients undergoing surgical management of CSM from January 2016 to December 2018. Education level was grouped as high school or below, graduate-level, and post-graduate level. The association of education level with baseline disease severity. Patient-reported measures (PROMs) included the North American Spine Society surgical satisfaction scale, Neck Disability Index (NDI), modified Japanese Orthopedic Association score (mJOA), arm and neck pain as numeric ranking scale (NRS), and quality-adjusted life-years (QALY).

Results: Among 1,141 patients with CSM included, 509 (44.6%) had an education level of high school or below. The three groups were significantly different in terms of SES index, proportion of smokers, symptom duration >3 months, and baseline PROMs. In multivariable analyses, lower education level was associated with symptom duration of >3 months, higher arm pain NRS, and higher neck pain NRS. All groups reported similar surgical satisfaction and minimal clinically important differences across all measures, except for neck pain.

Conclusion : Patients with CSM reporting a lower educational level tended to present with longer symptom duration, more disease-inflicted disability, higher pain scores, and lower QALY scores. These patients are a potentially vulnerable subpopulation, and their health literacy and access to care should be prioritized.