Socioeconomic Disparities in Diagnosis and Surgical Outcomes for Cervical Myelopathy: A Cohort Study in the Deep South

Introduction: Cervical Spondylotic Myleopathy (CSM) is one of the most common causes for spinal cord dysfunction among adults worldwide. Previous literature suggests that social determinants of health including race, socioeconomic status, and community support may impact spine surgery outcomes. However, there is a lack of literature examining the socioeconomic determinants of post-operative outcomes.

Methods: We performed a single-institution retrospective analysis of all adult patients undergoing spine surgery for the treatment of CSM from November 2010 to February 2022; patients were identified using ICD9/10 codes. Clinical data were retrospectively abstracted from the electronic medical records. Univariate and multivariate logistic regression were used to assess the relationship between socioeconomic variables and postoperative complication rates.

Results: A total of 490 patients (mean age: 60.211.3 years) who had undergone spine surgery for CSM were identified. After controlling for age, employment status and disability was a predictor of lower mJOA (OR 2.87, p< 0.001) as well as having higher Nurick disability (OR 2.77 p< 0.001) score on presentation. In univariate regression analysis, older age (OR 1.40, p< 0.001), hypertension (OR 1.72, p=0.016), peripheral vascular disease (OR 2.59, p=0.009), heart failure (OR 2.61, p=0.007), living in a skilled nursing facility (OR 3.00, p=0.006) and having undergone a posterior surgical approach (OR 1.69, p< 0.014) were predictors of complications. When controlling for age, unemployment (OR 2.65, p< 0.001) and retirement (OR 2.49, p=0.007) were predictors of having complications.

Conclusion : Employment status and insurance type appear to be significant predictors of post-operative outcomes and severity of myelopathy at presentation. Living status, as well as medical and surgical factors also predicted post-operative complications. These findings suggest socioeconomic factors play a significant and complex role in regards to CSM diagnosis and post surgical outcomes in CSM, warranting further prospective research in this region of the United States.