Trends in Nonoperative Treatment Modalities Prior to Cervical Surgery and Impact on Patient-Derived Outcomes: Two-Year Analysis of 1522 Patients From the Prospective Spine Treatment Outcome Study.

Authors

• Michael C Gerling
• Kris Radcliff
• Robert Isaacs
• Kristina Bianco
• Cyrus M Jalai
• Nancy J Worley
• Gregory W Poorman
• Samantha R Horn
• Olivia J Bono
• John Moon
• Paul M Arnold
• Alexander R Vaccaro
• Peter Passias

Publication/Presentation Date

4-1-2018

Abstract

BACKGROUND: Effects of nonoperative treatments on surgical outcomes for patients who failed conservative management for cervical spine pathologies remain unknown. The objective is to describe conservative modality use in patients indicated for surgery for degenerative cervical spine conditions and its impact on perioperative outcomes.

METHODS: The current study comprises a retrospective review of a prospective multicenter database. A total of 1522 patients with 1- to 2-level degenerative cervical pathology who were undergoing surgical intervention were included. Outcome measures used were health-related quality-of-life scores, length of hospitalization, estimated blood loss, length of surgery, and return-to-work status at 2 weeks, 6 months, 1 year, and 2 years postoperatively. Patients were grouped by diagnosis (radiculopathy vs. myelopathy), then divided based on epidural injection(s), physical therapy (PT), or opioid use prior to enrollment. Univariate

RESULTS: Among 1319 radiculopathy patients, 25.7% received preoperative epidural injections, 35.3% received PT, and 35.5% received opioids. Radiculopathy patients who received epidurals and PT had higher 1-year postoperative return-to-work rates (

CONCLUSIONS: Radiculopathy patients receiving epidurals returned to work after 1 year more frequently. PT was associated with shorter hospitalizations, greater SF-36 bodily pain norm and physical component score improvements, and increased return-to-work rates after 1 and 2 years. No statistically significant nonoperative treatment was associated with return-to-work rate in myelopathy patients.

CLINICAL RELEVANCE: These findings suggest certain preoperative conservative treatment modalities are associated with improved outcomes in radiculopathy patients.

Volume

12

Issue

2

First Page

250

Last Page

259

ISSN

2211-4599

Published In/Presented At

Gerling, M. C., Radcliff, K., Isaacs, R., Bianco, K., Jalai, C. M., Worley, N. J., Poorman, G. W., Horn, S. R., Bono, O. J., Moon, J., Arnold, P. M., Vaccaro, A. R., & Passias, P. (2018). Trends in Nonoperative Treatment Modalities Prior to Cervical Surgery and Impact on Patient-Derived Outcomes: Two-Year Analysis of 1522 Patients From the Prospective Spine Treatment Outcome Study. International journal of spine surgery, 12(2), 250–259. https://doi.org/10.14444/5031

Disciplines

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

PubMedID

30276082

Department(s)

Administration and Leadership

Document Type

Article