Cervical spine patients do well after surgery and in terms of outcomes that are most relevant to the patients themselves. Indeed, this new study raised an important question: Do non-patient reported outcome measures have a role in post-op evaluation systems? If so, which ones can deliver relevant data and how valid, based on objective study, can they be?
A team from New York City-based Hospital for Special Surgery and Weill Cornell Medicine tackled this intriguing question in a new study, “Recovery Kinetics After Cervical Spine Surgery,” which appeared in the December 15, 2023 edition of Spine.
First author Tejas Subramanian, B.E., a third-year medical student at Weill Cornell Medical, explained the team’s rationale and hypothesis for the study to OTW, “Currently most of the counseling and pre-operative expectations are based on individual practitioners’ experience and a ‘best guess’ as to how patients are going to do. This is, of course, useful and helpful to patients in most instances but it can be difficult to answer these questions in a data-driven way.”
“Because there was surprisingly little data on this topic in the literature, we wanted to introduce our experience to help frame the conversation for providers across the country. Of course, there will be some variability between doctors (for example, based on their comfort level with immobilization after surgery or patients-specific factors like bone quality, etc.) but we are hoping that the data we presented can help bring consistency to the pre-operative counseling for patients undergoing cervical surgery.”
The study enrolled 140 patients, of whom 70 were being treated with either anterior cervical discectomy and fusion (ACDF) and 70 were treated with cervical disk replacement (CDR). To measure outcomes, the team collected data on days to return to driving, return to work and days of opioid use after surgery.
Here is what the researchers documented:
- 98.2% of ACDF patients and 98% of CDR patients returned to driving in 16 and 12 days, respectively;
- 85.7% of ACDF patients and 90.9% of CDR patients returned to work in 16 and 14 days; and
- 98.3% of ACDF patients and 98.3% of CDR patients discontinued opioids in a median of 7 and 6 days.
“As a field, we have focused on patient-reported outcomes and disability for the past several years,” stated Subramanian to OTW. “This is critical, of course, and has helped advance our field and has established the value of spine procedures. While this remains important to our patients, ability is as important as disability, and I think that is something we are now starting to realize.”
“We are just more familiar with the language of complications and pain scores, but patients care deeply about their recovery from surgery and return to specific activities like driving, work, etc.”
“I think discussing a return to these activities is something we have not focused on enough as a field and I hope this paper and others published by our group serve as a framework for some of those discussions.”
“I think the most interesting finding was just how quickly patients are able to get back to most activities after these procedures; 98% of patients were driving and almost 90% were working by 16 days. Additionally, we found that patients recover in a similar fashion after ACDF and CDR.”
“We need to continue to work on defining return to activities to help our patients get a sense for what they need to do to prepare for surgery and when they can return to specific activities. Our next focus is to look at cervical and lumbar patients and how they return to more athletic pursuits (sports, etc.). I would also love to see similar manuscripts or data from other institutions so that we could have more generalizable data for providers to access.”
