Duration of preoperative radiculopathy symptoms associated with worse outcomes

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A recent study found that a longer duration of preoperative radiculopathy symptoms in patients with degenerative cervical pathology is associated with worse health-related quality of life (HRQOL) outcome measures after 1–3 level anterior cervical discectomy and fusion (ACDF) surgery. The results were presented by co-author Dhruv Goyal (Rothman Orthopaedic Institute, Philadelphia, USA) at the 19th Annual Conference of the International Society for the Advancement of Spinal Surgery (ISASS; 3–5 April 2019, Anaheim, USA).

Lead author Danial Tarazona (Rothman Orthopaedic Institute) and colleagues conclude that it is “important not to delay surgery in patients with degenerative cervical radiculopathy to optimise patient outcomes after ACDF”. They note that while a longer duration of cervical myelopathy symptoms has been associated with worse outcomes however, there is limited data on the duration of radicular symptoms and outcomes. The purpose of this study was therefore to determine the influence that duration of radicular symptoms has on HRQOL outcome measures.

The investigators describe the study as a retrospective analysis of prospectively collected HRQOL outcomes data involving adults with cervical radiculopathy treated with 1–3 level ACDF surgery. Patients with less than one year of clinical follow-up were excluded from the study. Once enrolled the cohort was divided into three groups: 86 were included in the group of patients with less than six months of preoperative radicular symptoms; 61 in the group with six months to two years of preoperative radicular symptoms; and 69 in the group with over two years of symptoms.

Tarazona and colleagues measured various outcomes, specifically the SF-12 physical and mental composite scores, neck disability index, visual analogue scale neck and arm pain scores, and reoperation rates. They describe how statistics were collected using one-way ANOVA (Turkey post-hoc testing), the Chi-Square test, and multivariate analyses.

The investigators found that in a cohort of 216 patients, there were no significant baseline differences in HRQOL outcome scores between the three different groups. Postoperatively, patients with a longer duration of radiculopathy symptoms had significantly worse outcomes in all of the HRQOL domains, with the only exception being the SF-12 mental component score. The authors’ multivariate analysis indicated that a longer duration of preoperative symptoms predicted worse outcome scores in all HRQOL categories tested.

Tarazona and colleagues detailed that the mean age of the patients was 51.9 years (range: 23–84), mean BMI was 29.4 (range: 18.8–54.9), and mean clinical follow-up was 16 months (range: 12–46.1).

“Patients should be counselled that delaying surgery may result in less than optimal results,” Tarazona tells Spinal News International. “Specifically, cervical radiculopathy for more than six months results in less improvement in disability and pain. Furthermore, symptoms for more than two years was an independent predictor of worse HRQOL.”

Commenting on the strengths of the study, Tarazona notes the extensive evaluation of several HRQOL outcome measures, which “allowed for a closer evaluation of the impact of duration of symptoms on pain, disability, mental health, and physical health. This allows for providers to give a more accurate representation of the outlook of their outcome.” In addition, he notes that the sample size was larger than prior studies and added to the “robustness” of their investigation.

“There were a few notable limitations,” remarks Tarazona, specifically the retrospective nature of the study, which meant it was subject to “all of the inherent biases” of this design, and the fact that the exact DOS was not available. “While it was the authors’ intention to determine the exact DOS for every patient,” he comments, “this was not feasible in the patients with subacute and chronic symptoms, as they were often unclear on the exact start of the symptoms.”


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