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Is there Regional Variation across the United States in outcomes for patients undergoing a 1, 2, or 3-level ACDF for CSM? – A Quality Outcomes Database study

Friday, May 3, 2024

Presenting Author(s)

Michael E. Tawil, BS

Medical Student
University of California San Francisco
San Francisco, CA, US

Co-Author(s)

Nima Alan, MD

Neurosurgeon
UCSF
Phoenix, Arizona, United States
Anthony L. Asher, MD

President AANS, Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, North Carolina, United States
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Mohamad Bydon, MD

Professor of Neurosurgery
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, Minnesota, United States
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
Oren Gottfried, MD (he/him/his)

Professor of Neurosurgery
Duke University
Durham, NC, US
Regis William Haid, Jr., MD

Neurosurgeon
Atlanta Brain and Spine
Atlanta, Georgia, United States
John Knightly, MD

Director of Neurosurgery
Atlantic Neurosurgical Specialists
Morristown, New Jersey, United States
SM

Scott Meyer, MD

Neurosurgeon
Altair Health
Minneapolis, Minnesota, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
Paul Park, MD

Neurosurgeon
Semmes Murphey Clinic
MEMPHIS, Tennessee, United States
Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, NC, US
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, VA, US
Luis M. Tumialán, MD

Professor of Neurosurgery
Barrow Brain and Spine
Paradise Valley, Arizona, United States
Jay D. Turner, MD, PhD

Neurosurgery Faculty
Barrow Neurological Institute
Phoenix, AZ, US
Cheerag Upadhyaya, MD, MBA (he/him/his)

Vice Chair of Outpatient Operations, Chief of Business Development and Strategy, Associate Professor of Neurosurgery
University of North Carolina
Chapel Hill, North Carolina, United States
JU

Juan Uribe, MD

Vice Char of Neurosurgery
Barrow Neurological Institute
bogota, Colombia
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, New York, United States
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US
SZ

Samer Zammar, MD

Neurosurgery Fellow
Penn State Health, California, United States

Introduction: In the United States, there is regional variations in the outcomes of spine surgery for various pathologies. Here we study the regional variation in patients who underwent anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM).

Methods: We queried the Quality Outcomes Database from the 14 highest enrolling sites for patients diagnosed with CSM and underwent 1, 2, or 3-level ACDF. Our primary outcome measure to assess regional variation was the minimal clinically important difference (MCID) in patient-reported outcomes (PROs), including neck disability index (NDI) and EuroQol 5 Dimension 5 (EQ-5D) scores at baseline and 24 months postoperatively.

Results: Among the 1141 patients that underwent surgery for CSM, 396 patients underwent a 1, 2, or 3 level ACDF with baseline and 24-month PROs available. The number of patients per region included: Northeast (n = 61), South (n = 154), Midwest (n = 114), and West (n = 67).

For the entire cohort, there were no statistical differences in regional variations for the percentage of patients who achieved MCID for NDI (p=0.121) or EQ-5D (p=0.257).

In subanalysis of patients who underwent 1-level ACDFs (n = 170), the Midwest had the highest percentage of patients who achieved MCID for NDI (83.3%), followed by the Northeast with 23 patients (76.7%), the West with 14 patients (53.8%), and the South with 32 patients (53.3%) (p=0.002). No difference was found in the percentage of patients achieving MCID for EQ-5D (p=0.331). In multivariate regression, region was not predictive of achieving MCID for NDI (p > 0.05).

In similar subanalyses in patients who underwent 2- level, or 3-level ACDF there were no significant regional variations in MCID for NDI or EQ-5D.

Conclusion : In the United States, there is no difference in outcomes among regions for patients undergoing a 1, 2 or 3 level ACDF.