Tag: Neck pain

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Using the Quality Outcomes Database to Identify Minimum Clinically Important Differences for Patients With Cervical Spondylotic Myelopathy

Neurosurgery 98:1347–1358, 2026

This multicenter retrospective analysis of 1,141 surgical cases from the Quality Outcomes Database defines optimal minimum clinically important differences (MCIDs) for commonly used patient-reported outcome measures (PROMs) in cervical spondylotic myelopathy (CSM). The study compares several MCID calculation methods using AUCs anchored to patient satisfaction at 3- and 24-month follow-ups to identify the most predictive thresholds.

Key findings report a ≥30% improvement from baseline as the preferred MCID for NDI and neck/arm NRS, severity-adjusted point increases for mJOA, and absolute numeric cutoffs for EQ-5D (0.065 at 3 months; 0.149 at 24 months). Achievement rates and implications for clinical decision-making and benchmarking across centers are provided.

Aim Identify the most appropriate MCID thresholds for common PROMs in surgical cervical spondylotic myelopathy (CSM) using the Quality Outcomes Database (QOD) cohort.

Cohort Analyze 1141 CSM surgical cases across 14 sites (enrolled 2016–2018) with a 24-month follow-up rate of 87.6% (excluding 2.5% deaths).

PROMs Use baseline, 3-month, and 24-month outcomes for NDI, EQ-5D (QALYs), mJOA, and neck/arm pain NRS, with patient satisfaction as the anchor.

Anchor/AUC method Define “satisfied” using the NASS satisfaction scale (responses 1–2) vs “not satisfied” (3–4), then compare MCID methods by AUC for predicting satisfaction.

NDI & pain MCID A ≥30% improvement from baseline is the preferred/optimal MCID benchmark for NDI and neck/arm pain NRS (close to the best-performing ROC-derived percentage cutoffs).

EQ-5D MCID Absolute numeric cutoffs outperform other methods for EQ-5D: +0.065 QALYs (3 months) and +0.149 QALYs (24 months).

mJOA MCID A severity-adjusted approach performs best for mJOA: improvement of ≥1 (mild), ≥2 (moderate), or ≥3 (severe) points.

MCID achievement (24 months) MCIDs are achieved by 63% (NDI), 59% (neck pain NRS), 61% (arm pain NRS), 52% (EQ-5D), and 59% (mJOA) of patients.

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Conservative Management of Type II Odontoid Fractures in Older People

Neurosurgery 2020 DOI:10.1093/neuros/nyaa256

Type II odontoid fractures are a common cervical fracture in older people. Lower osseous-union rates are reported in those treated conservatively compared to surgically; however, the clinical relevance of a nonunion is unknown.

OBJECTIVE: To compare pain, disability, and quality of life in older people following conservativemanagement of type II odontoid fractures demonstrating osseous-union and nonunion.

METHODS: Electronic records were searched from 2008 to 2018 for adults ≥65 yr with type II odontoid fracture, managed in a semi-rigid collar. Clinical and demographic data were retrieved from electronic patient notes. Surviving patients were invited to complete questionnaires to assess pain, disability, and quality of life. Ethical approval was granted.

RESULTS: A total of 125 patients were identified: 36 (29%) demonstrated osseous-union, 89 (71%) had nonunion, of which 33 (40%) had radiological instability. Mean age at fracture was 84 yr (osseous-union 83 yr; nonunion 84 yr). A total of 53 had deceased (41 nonunion). Median length of survival was 77 mo for osseous-union vs 50 mo for nonunion; P = .02. No patient developed myelopathy during the follow-up period. Questionnaire response rate was 39 (58%). There were no statistically significant differences between the groups in terms of pain, disability, or quality of life (P>.05). Both groups reported mild disability and pain but low quality of life.

CONCLUSION: Management with a semi-rigid collar in older people with type II odontoid fracture is associated with low levels of pain and disability without statistically significant differences between those demonstrating osseous-union or stable or unstable nonunions. Conservative management appears to be a safe treatment for older people with type II fractures.

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Crossing the Cervicothoracic Junction During Posterior Cervical Fusion for Myelopathy Is AssociatedWith Superior Radiographic Parameters But Similar Clinical Outcomes

Neurosurgery 2020 DOI:10.1093/neuros/nyaa241

For laminectomy and posterior spinal fusion (LPSF) surgery for cervical spondyloticmyelopathy (CSM), the evidence is unclear as to whether fusions should cross the cervicothoracic junction (CTJ). OBJECTIVE: To compare LPSF outcomes between those with and without lower instrumented vertebrae (LIV) crossing the CTJ.

METHODS: A consecutive series of adults undergoing LPSF for CSM from 2012 to 2018 with a minimum of 12-mo follow-up were identified. LPSF with subaxial upper instrumented vertebrae and LIV between C6 and T2 were included. Clinical and radiographic outcomes were compared.

RESULTS: A total of 79 patients were included: 46 crossed the CTJ (crossed-CTJ) and 33 did not. The mean follow-up was 22.2 mo (minimum: 12 mo). Crossed-CTJ had higher preoperative C2-7 sagittal vertical axis (cSVA) (33.3 ± 16.0 vs 23.8 ± 12.4 mm, P = .01) but similar preoperative cervical lordosis (CL) and CL minus T1-slope (CL minus T1-slope) (P > .05, both comparisons). The overall reoperation rate was 3.8% (crossed-CTJ: 2.2% vs notcrossed: 6.1%, P=.37). In adjusted analyses, crossed-CTJ was associated with superior cSVA (β = –9.7; P = .002), CL (β = 6.2; P = .04), and CL minus T1-slope (β = –6.6; P = .04), but longer operative times (β = 46.3; P = .001). Crossed- and not-crossed CTJ achieved similar postoperative patient-reported outcomes [Visual Analog Scale (VAS) neck pain, VAS arm pain, Nurick Grade, Modified Japanese Orthopedic Association Scale, Neck Disability Index, and EuroQol-5D] in adjusted multivariable analyses (adjusted P > .05). For the entire cohort, higher postoperative CL was associated with lower postoperative arm pain (adjusted Pearson’s r –0.1, P=.02). No postoperative cervical radiographic parameters were associated with neck pain (P > .05).

CONCLUSION: Subaxial LPSF for CSM that crossed the CTJ were associated with superior radiographic outcomes for cSVA, CL, and CL minus T1-slope, but longer operative times. There were no differences in neck pain or reoperation rate.

 

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Cervical Laminectomy vs Laminoplasty: Is There a Difference in Outcome and Postoperative Pain?

Neurosurgery 70:965–970, 2012 DOI: 10.1227/NEU.0b013e31823cf16b 

Cervical laminoplasty is often used for the decompression of multilevel cervical spondylotic myelopathy without creating spinal instability and kyphosis.

OBJECTIVE: To assess the axial pain, quality of life, sagittal alignment, and extent of decompression after standard cervical laminectomy or laminoplasty. We further evaluate whether the sagittal alignment changes over time after both procedures and whether axial pain depends on sagittal alignment.

METHODS: We reviewed 268 patients with cervical radiculopathy or myelopathy who had undergone standard cervical laminectomy or laminoplasty between January 1999 and January 2009. The clinical outcome was analyzed by visual analog scale for neck pain. The quality of life was analyzed by EQ-5D questionnaire. The degree of deformity and extent of decompression were assessed using the Ishihara index and Pavlov’s ratio, respectively.

RESULTS: Laminoplasty was associated with more neck pain and worse quality of life when 4 or more levels were decompressed compared with the laminectomy group. For operations of 3 or fewer levels, there was no difference. Interestingly, the radiological effectiveness of decompression was greater in the laminoplasty group.

CONCLUSION: Laminoplasty for 4 or more cervical levels was associated with more axial pain and consequently poorer quality of life than laminectomy. There was a similar loss of sagittal alignment in both the laminectomy and laminoplasty groups over time. Our results suggest there is no clear benefit of laminoplasty over laminectomy in patients who do not have spinal instability.

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