Effect of Modified Japanese Orthopedic Association Severity Classifications on Satisfaction With Outcomes 12 Months After Elective Surgery for Cervical Spine Myelopathy.

Authors

• Anthony L Asher
• Clinton J Devin
• Benjamin M Weisenthal
• Jacquelyn Pennings
• Inamullah Khan
• Kristin R Archer
• Ahilan Sivaganesan
• Silky Chotai
• Mohamad Bydon
• Hui Nian
• Frank E Harrell
• Matthew J McGirt
• Praveen Mummaneni
• Erica F Bisson
• Christopher Shaffrey
• Kevin T Foley

Publication/Presentation Date

6-1-2019

Abstract

STUDY DESIGN: This study retrospectively analyzes prospectively collected data.

OBJECTIVE: Here, we aim to determine the influence of preoperative and 12-month modified Japanese Orthopedic Association (mJOA) on satisfaction and understand the change in mJOA severity classification after surgical management of degenerative cervical myelopathy (DCM).

SUMMARY OF BACKGROUND DATA: DCM is a progressive degenerative spine disease resulting from cervical cord compression. The natural progression of DCM is variable; some patients experience periods of stability, while others rapidly deteriorate following disease onset. The mJOA is commonly used to grade and categorize myelopathy symptoms, but its association with postoperative satisfaction has not been previously explored.

METHODS: The quality and outcomes database (QOD) was queried for patients undergoing elective surgery for DCM. Patients were divided into mild (≥14), moderate (9 to 13), or severe (< 9) categories on the mJOA scores. A McNemar-Bowker test was used to assess whether a significant proportion of patients changed mJOA category between preoperative and 12 months postoperative. A multivariable proportional odds ordinal logistic regression model was fitted with 12-month satisfaction as the outcome of interest.

RESULTS: We identified 1963 patients who underwent elective surgery for DCM and completed 12-months follow-ups. Comparing mJOA severity level preoperatively and at 12 months revealed that 55% remained in the same category, 37% improved, and 7% moved to a worse category. After adjusting for baseline and surgery-specific variables, the 12-month mJOA category had the highest impact on patient satisfaction (P <  0.001).

CONCLUSION: Patient satisfaction is an indispensable tool for measuring quality of care after spine surgery. In this sample, 12-month mJOA category, regardless of preop mJOA, was significantly correlated with satisfaction. Given these findings, it is important to advise patients of the probability that surgery will change their mJOA severity classification and the changes required to achieve postoperative satisfaction.

LEVEL OF EVIDENCE: 3.

Volume

44

Issue

11

First Page

801

Last Page

808

ISSN

1528-1159

Published In/Presented At

Asher, A. L., Devin, C. J., Weisenthal, B. M., Pennings, J., Khan, I., Archer, K. R., Sivaganesan, A., Chotai, S., Bydon, M., Nian, H., Harrell, F. E., Jr, McGirt, M. J., Mummaneni, P., Bisson, E. F., Shaffrey, C., Foley, K. T., & for QOD Vanguard Sites (2019). Effect of Modified Japanese Orthopedic Association Severity Classifications on Satisfaction With Outcomes 12 Months After Elective Surgery for Cervical Spine Myelopathy. Spine, 44(11), 801–808. https://doi.org/10.1097/BRS.0000000000002946

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

30475334

Department(s)

Administration and Leadership

Document Type

Article