Elsevier

World Neurosurgery

Volume 109, January 2018, Pages e144-e149
World Neurosurgery

Original Article
Two-Year Results of the Prospective Spine Treatment Outcomes Study: Analysis of Postoperative Clinical Outcomes Between Patients with and without a History of Previous Cervical Spine Surgery

https://doi.org/10.1016/j.wneu.2017.09.122Get rights and content

Objective

History of previous cervical spine surgery is a frequently cited cause of worse outcomes after cervical spine surgery. The purpose of this study was to determine any differences in clinical outcomes after cervical spine surgery between patients with and without a history of previous cervical spine surgery.

Methods

A multicenter prospective database was reviewed retrospectively to identify patients with cervical spondylosis undergoing surgery with a minimum 2-year follow-up. Patients were divided into 2 groups: patients with (W) or without (WO) previous history of cervical spine surgery. Statistical analyses of Health-Related Quality of Life scores were analyzed with statistical software to fit linear mixed models for continuous longitudinal outcome.

Results

A total of 1286 patients (377 W, 909 WO) met criteria for inclusion. Overall, patients in both groups experienced an improvement in their Health-Related Quality of Life scores. However, patients in the W group had significantly decreased improvement compared with WO patients in the Neck Disability Index score and the following SF-36 domain scores: Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Health Transition, and Physical Component Summary at all time points (P < 0.05). There was no statistically significant difference between the W and WO groups in operative time, estimated blood loss, length of stay, or complications (P > 0.05).

Conclusions

Patients with a history of previous cervical spine surgery had inferior improvement in quality of life outcome scores. Patients with a history of previous surgical intervention who elect to undergo subsequent surgeries should be appropriately counseled about expected results.

Introduction

Clinical disorders of the cervical spine have a variety of causes but are caused most frequently by degenerative and age-related changes. These changes result in canal or foraminal stenosis, which can manifest as myelopathy, radiculopathy, or neck pain.1, 2, 3 Although the natural history of cervical disease is hard to predict, it is commonly characterized by a progressive, stepwise decline. Surgical intervention for cervical spondylosis has been shown to improve clinical outcomes and quality of life.4, 5

Improvements in surgical technique along with an aging population have led to increased use of cervical spine surgery. As cervical spine surgery becomes more common, an increasing number of patients will require secondary or revision procedures.1 Although the risks inherent in primary cervical spine surgery are well documented, there are additional considerations involved with each subsequent surgery, which remain to be fully analyzed.6, 7 Although previous reports have included previous spine surgery as a risk factor for poor outcomes, few studies have directly compared the outcomes between primary and revision spinal surgery.

Considering the paucity of literature specifically evaluating patient-reported outcomes after a history of previous cervical spinal surgery, the purpose of this study was to determine differences in outcomes and quality of life between cervical patients who underwent previous surgery compared with those who did not undergo previous surgery. An improved understanding of the clinical outcomes and complications after revision spine surgery may improve our ability to counsel patients before these procedures in regard to their expected recovery.

Section snippets

Materials and Methods

This study was a retrospective review of a prospectively collected multi-institutional database that contained information on patients undergoing surgical treatment for cervical pathology. This prospective spine outcomes registry included 2221 patients, of whom 1818 received operative treatment and 403 underwent nonoperative management. Of the 1818 who underwent operative treatment, 1286 met our criteria for inclusion.

Inclusion criteria for this study were patients older than the age of 18 who

Results

The study population included a total of 1286 patients with cervical pathology, of whom 377 had a history of previous spine surgery (W), and 909 without (WO). The baseline demographics for the study population are displayed in Table 1. There were no significant differences between the 2 experimental groups on the basis of age (W: 51.5 vs. WO: 50.5 years, P > 0.05), body mass index (W: 28.6 vs. WO: 28.8 kg/m2, P > 0.05), or current smoking habits (W: 30.4% vs. WO: 29.0%, P = 0.642). The W group

Discussion

The decision to perform revision cervical spine surgery on patients who have a history of previous cervical spine surgery requires careful consideration of risks and benefits. The clinician must appropriately counsel the patient on the expected outcomes after choosing to undergo elective revision surgery. Indications for revision surgery vary but commonly include pseudarthrosis, wound infection, device failure, and progressive deformity.8 The purpose of this study was to identify differences in

Conclusions

Using a multicenter prospective database, we found that patients who had a history of previous cervical spine surgery had less improvement in quality of life outcome scores when undergoing cervical spine surgery compared with those who did not undergo previous surgery, despite overall improvement after surgery. Patients with cervical pathology with a history of previous surgical intervention who elect to undergo subsequent surgeries should be appropriately counseled about expected results.

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Conflict of interest statement: Dr. Radcliff reports personal fees from Globus Medical, 4 Web Medical, Medtronic Advanced Energy, DePuy, Globus, LDR, Orthopedic Sciences, Inc., NuVasive, and NEXXT Spine and grants from Pacira Pharmaceuticals, outside the submitted work. Non-financial—Boards of Directors: Association for Collaborative Spinal Research and Scientific Advisory Board: 4 Web Medical, outside the submitted work. Dr. Isaacs reports grants and personal fees from NuVasive, Inc., personal fees from Association for Collaborative Spine research, and serves as Scientific Advisor for Providence Medical Technology, outside the submitted work. Dr. Vaccaro reports personal fees from Medtronics, Striker Spine, Biomet Spine, Globus, Aesculap, Thieme, Jaypee, Elseviere, Taylor Francis, DePuy, Medtronics, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Expert testimony, Ellipse, Vertex, and stock ownership in Replication Medica, Paradigm Spine, Stout Medical, Progressive Spinal Technologies Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, Small Bone Innovations, Cross Current, In Vivo, Flaghsip Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I, Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical, outside the submitted work. Non-financial—Scientific Advisory Board for AO Spine, Innovative Surgical Design, and Association for Collaborative Spine Research, outside the submitted work. Dr. Passias reports consultancy from Medicrea & SpineWave and personal fees from Zimmer Biomet, and a grant from CSRS, outside the submitted work. The remaining authors have no conflicts to report.

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