1562. Effect of myelopathy on outcomes after cervical disc replacement: A study of a local patient cohort and a large national cohort

Authors: Andre Samuel; Avani Vaishnav, MBBS; Steven McAnany, MD; Todd Albert, MD; Sravisht Iyer, MD; Catherine Himo Gang, MPH; Sheeraz Qureshi (New York, NY)

Introduction:

Previous research has shown increased perioperative morbidity after anterior cervical discectomy and fusion (ACDF) for patients with myelopathy. However the association of myelopathy with outcomes after CDR has not yet been shown.

Methods:

Consecutive patients undergoing CDR by a single surgeon were identified and patients undergoing CDR in the 2015 and 2016 National Surgical Quality Improvement Program (NSQIP) database were identified. Patients with a preoperative diagnosis of cervical myelopathy were identified in both cohort, and perioperative outcomes and short-term postoperative outcomes were compared between patients with and without myelopathy. Comparisons were also controlled based on the number of levels treated.

Results:

A total of 27 patients were identified in the institutional cohort, 12 patients (44.4%) with myelopathy. A total of 3,023 patients were identified in the national cohort, 411 (13%) with myelopathy. In the institutional cohort (Table 1), the non-myelopathy group saw significant improvements in neck disability index (NDI), and visual analog scale (VAS) neck and arm pain at both 2 weeks and 6 weeks post-operatively. The myelopathy group only saw a significant improvement in NDI at 6 weeks (-13.1± 4.1, P < 0.05)) but not at 2 weeks (P > 0.05). In the national cohort (Table 2), myelopathy was associated with longer operative time and length of stay, even after controlling for the number of levels treated (P < 0.05). However, there was no significant difference in perioperative complications (P > 0.05).

Conclusion:

Myelopathy is not associated with increased perioperative morbidity and complications after CDR. Significant improvement in patient reported outcomes is seen at 6 weeks in myelopathy patients, although more rapid improvement is seen in patients without myelopathy.