NDI <21 Denotes Patient Acceptable Symptom State After Degenerative Cervical Spine Surgery

医学 最小临床重要差异 脊髓病 接收机工作特性 椎板切除术 外科 回顾性队列研究 颈椎前路椎间盘切除融合术 颈椎 颈椎 内科学 随机对照试验 脊髓 精神科
作者
Pratyush Shahi,Tejas Subramanian,None Nishtha Singh,Daniel Shinn,Sidhant S. Dalal,Junho Song,Kasra Araghi,Dimitra Melissaridou,Evan D. Sheha,James Dowdell,Sheeraz A. Qureshi,Sravisht Iyer
出处
期刊:Spine [Ovid Technologies (Wolters Kluwer)]
卷期号:48 (11): 766-771 被引量:1
标识
DOI:10.1097/brs.0000000000004493
摘要

Study Design. Retrospective review of prospectively collected data. Objective. To determine the Neck Disability Index (NDI) cut-off for achieving patient acceptable symptom state (PASS) at 6 months following degenerative cervical spine surgery. Summary of Background Data. An absolute score denoting PASS might be a better marker to assess clinical outcomes than a change score denoting minimal clinically important difference (MCID). Methods. Patients who underwent primary anterior cervical decompression and fusion (ACDF), cervical disc replacement (CDR), or laminectomy were included. The outcome measure was NDI. The anchor used to assess PASS achievement at 6 months was the response on the Global Rating Change (GRC): “Compared to preoperative, you feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or 5) much worse.” It was converted to a dichotomous outcome variable (acceptable=response of 1 or 2, unacceptable=response of 3,4, or 5) for analyses. The overall cohort and subgroups based on age (≤65 y, >65 y), gender, myelopathy, and preoperative NDI (≤40, >40) were analyzed for the proportion of patients achieving PASS and the NDI cut-off using receiver operator curve (ROC). Results. 75 patients (42 ACDF, 23 CDR, 10 laminectomy) were included. 79% of patients achieved PASS. Males, patients with age ≤65 y, preoperative NDI ≤40, and absence of myelopathy were more likely to achieve PASS. The ROC analysis revealed an ODI cut-off of 21 to achieve PASS (area under the curve, AUC: 0.829, sensitivity: 81%, specificity: 80%). The subgroup analyses based on age, gender, myelopathy, and preoperative NDI revealed AUCs >0.7 and NDI threshold values consistent between 17 and 23. Conclusions. With an AUC of 0.829, NDI showed an excellent discriminative ability. Patients with NDI ≤21 are expected to achieve PASS following degenerative cervical spine surgery. Level of evidence. 4.
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