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

Asher, Anthony L., MD; Devin, Clinton J., MD; Weisenthal, Benjamin M., MD; Pennings, Jacquelyn, PhD; Khan, Inamullah, MD; Archer, Kristin R., PhD, DPT†,‡; Sivaganesan, Ahilan, MD§; Chotai, Silky, MD§; Bydon, Mohamad, MD; Nian, Hui, PhD||; Harrell, Frank E. Jr., PhD||; McGirt, Matthew J., MD; Mummaneni, Praveen, MD∗∗; Bisson, Erica F., MD††; Shaffrey, Christopher, MD‡‡; Foley, Kevin T., MD§§; for QOD Vanguard Sites

doi: 10.1097/BRS.0000000000002946
HEALTH SERVICES RESEARCH
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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

Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease resulting from cervical cord compression. Utilizing data from multi-institutional, national spine registry, we aim to determine the influence of preoperative and 12-month mJOA on satisfaction; and understand the change in mJOA severity classification after surgical management of DCM.

Carolina Neurosurgery and Spine Associates, Carolinas Healthcare System, Charlotte, NC

Department of Orthopaedic Surgery, Vanderbilt University School of Medicine, Nashville, TN

Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN

§Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, TN

Department of Neurological Surgery, Mayo Clinic, Rochester, MN

||Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN

∗∗Department of Neurological Surgery, University of California, San Francisco, CA

††Department of Neurosurgery, University of Utah, Salt Lake City, UT

‡‡Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA

§§Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes-Murphey Neurologic and Spine Institute, Memphis, TN.

Address correspondence and reprint requests to Clinton J. Devin, MD, Department of Orthopedics Surgery, Vanderbilt Spine Center, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774; E-mail: clinton.j.devin@vanderbilt.edu; Inamullah Khan, MD, Nashville, TN; E-mail: inamullah.khan@vumc.org

Received 12 July, 2018

Revised 27 October, 2018

Accepted 5 November, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, royalties, stocks, expert testimony.

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