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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.
Spine 2018 November 21
STUDY DESIGN: This study retrospectively analyzes prospectively collected data.
OBJECTIVE: Here 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.
SUMMARY OF BACKGROUND DATA: Degenerative cervical myelopathy (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 modified Japanese Orthopedic Association (mJOA) is commonly used to grade and categorize myelopathy symptoms, but its association with post-operative satisfaction has not been previously explored.
METHODS: The QOD (Quality and Outcomes Database) 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 < .001).
CONCLUSION: Patient satisfaction is an indispensable tool for measuring quality of care following 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 post-operative satisfaction.
LEVEL OF EVIDENCE: 3.
OBJECTIVE: Here 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.
SUMMARY OF BACKGROUND DATA: Degenerative cervical myelopathy (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 modified Japanese Orthopedic Association (mJOA) is commonly used to grade and categorize myelopathy symptoms, but its association with post-operative satisfaction has not been previously explored.
METHODS: The QOD (Quality and Outcomes Database) 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 < .001).
CONCLUSION: Patient satisfaction is an indispensable tool for measuring quality of care following 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 post-operative satisfaction.
LEVEL OF EVIDENCE: 3.
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