Pre-operative expectations of patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

Alwalaa Althagafi; Nicolas Dea; Nathan Evaniew; Raja Y Rampersaud; W Bradley Jacobs; Jérome Paquet; Jefferson R Wilson; Hamilton Hall; Christopher S Bailey; Michael H Weber; Andrew Nataraj; Najmedden Attabib; David W Cadotte; Philippe Phan; Sean D Christie; Charles G Fisher; Neil Manson; Kenneth Thomas; Greg McIntosh; Raphaële Charest-Morin

doi:10.1016/j.spinee.2024.04.027

Pre-operative expectations of patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

Spine J. 2024 Apr 26:S1529-9430(24)00186-4. doi: 10.1016/j.spinee.2024.04.027. Online ahead of print.

Authors

Alwalaa Althagafi¹, Nicolas Dea¹, Nathan Evaniew², Raja Y Rampersaud³, W Bradley Jacobs², Jérome Paquet⁴, Jefferson R Wilson⁵, Hamilton Hall⁶, Christopher S Bailey⁷, Michael H Weber⁸, Andrew Nataraj⁹, Najmedden Attabib¹⁰, David W Cadotte², Philippe Phan¹¹, Sean D Christie¹², Charles G Fisher¹, Neil Manson¹⁰, Kenneth Thomas², Greg McIntosh¹³, Raphaële Charest-Morin¹⁴

Affiliations

¹ Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, 818 West 10(th) avenue, Vancouver, British Columbia V5Z 1M9, Canada.
² Combined Neurosurgical and Orthopedic Spine Program, University of Calgary, 1403 - 29th Street N.W, Calgary, Alberta T2N 2T9, Canada.
³ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 522 University Ave Suite 1001, Toronto, Ontario M5G 2C4, Canada; Orthopaedics, Department of Surgery, University of Toronto, 149 College St room 508-a, Toronto, Ontario M5T 1P5, Canada.
⁴ Centre de Recherche CHU de Quebec, CHU de Quebec-Universite Laval, 1401 18e Rue, Quebec City, Quebec G1J 1Z4, Canada.
⁵ Divisions of Orthopaedic and Neurosurgery, University of Toronto, 149 College St room 508-a, Toronto, Ontario M5T 1P5, Canada.
⁶ Department of Surgery, University of Toronto, 149 College St room 508-a, Toronto, Ontario M5T 1P5, Canada.
⁷ Department of Orthopedics Surgery, London Health Science Centre, Western University, 339 Windermere Rd, London, Ontario N6A 5A5, Canada.
⁸ Department of Orthopedics Surgery, McGill University Health Centre, 1650 Cedar Ave, #B5.159.6, Montreal, Quebec H3G 1A4, Canada.
⁹ Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, 2D, Walter C Mackenzie Health Sciences Centre - 8440-112 Street, Edmonton, Alberta T6G 2B7, Canada.
¹⁰ Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health Network, 400 University Ave., Saint John, New Brunswick E2L 4L2, Canada.
¹¹ Department of Orthopedics Surgery, The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada.
¹² Division of Neurosurgery, Dalhousie University, 3806 - 1796 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada.
¹³ Canadian Spine Outcomes and Research Network, Box 1053, Markdale, Ontario N0C 1H0, Canada.
¹⁴ Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia, 818 West 10(th) avenue, Vancouver, British Columbia V5Z 1M9, Canada. Electronic address: raphaele.charestmorin@vch.ca.

PMID: 38679073
DOI: 10.1016/j.spinee.2024.04.027

Abstract

Background: Despite an abundance of literature on degenerative cervical myelopathy (DCM), little is known about pre-operative expectations of these patients.

Purpose: The primary objective was to describe patient pre-operative expectations. Secondary objectives included identifying patient characteristics associated with high pre-operative expectations and to determine if expectations varied depending on myelopathy severity.

Study design: This was a retrospective study of a prospective multicenter, observational cohort of patients with DCM.

Patient sample: Patients who consented to undergo surgical treatment between January 2019 and September 2022 were included.

Outcomes measures: An 11-domain expectation questionnaire was completed pre-operatively whereby patients quantified the expected change in each domain.

Methods: The most important expected change was captured. A standardized expectation score was calculated as the sum of each expectation divided by the maximal possible score. The high expectation group was defined by patients who had an expectation score above the 75th percentile. Predictors of patients with high expectations were determined using multivariable logistic regression models.

Results: There were 262 patients included. The most important patient expectation was preventing neurological worsening (40.8%) followed by improving balance when standing or walking (14.5%), improving independence in everyday activities (10.3%), and relieving arm tingling, burning and numbness (10%). Patients with mild myelopathy were more likely to select no worsening as the most important expected change compared to patients with severe myelopathy (p<.01). Predictors of high patient expectations were: having fewer comorbidities (OR -0.30 for every added comorbidity, 95% CI -0.59 to -0.10, p=.01), a shorter duration of symptoms (OR 0.92, 95% CI 0.35-1.19, p=.02), no contribution from "failure of other treatments" on the decision to undergo surgery (OR 1.49, 95% CI 0.56-2.71, p=.02) and more severe neck pain (OR 0.19 for 1 point increase, 95% CI 0.05-0.37, p=.01).

Conclusions: Most patients undergoing surgery for DCM expect prevention of neurological decline, better functional status, and improvement in their myelopathic symptoms. Stopping neurological deterioration is the most important expected outcomes by patients.

Keywords: Degenerative cervical myelopathy; Functional outcomes; High expectations; Pre-operative expectation; Prevention of worsening; Severity of myelopathy.