Correlation of mJOA, PROMIS physical function, and patient satisfaction in patients with cervical myelopathy: an analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC) database

Squires, Mathieu; Schultz, Lonni; Schwalb, Jason M.; Park, Paul; Chang, Victor; Nerenz, David R.; Perez-Cruet, Miguelangelo; Abdulhak, Muwaffak; Khalil, Jad G.; Aleem, Ilyas

doi:10.1016/j.spinee.2022.12.016

Cited by 4 publications

(6 citation statements)

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“…Our study also found that most patients (85.6%) were satisfied with surgery. This is generally consistent with prior literature showing similar rates of satisfaction, including 77% satisfied after 2 years in a cohort of 288 patients and 80% satisfied after an average follow-up of 9.3 years in a cohort of 69 patients 10,36 …”

Section: Discussionsupporting

confidence: 91%

“…Squires et al found in an analysis of 2023 patients with cervical myelopathy from the Michigan Spine Surgery Improvement Collaborative (MSSIC) that both change in mJOA and change in PROMIS PF were strongly related to patient satisfaction (P < 0.001). 10 Zaki et al reports correlations between outcome questionnaires and patient satisfaction from our QOD CSM cohort. 11 NASS satisfaction was negatively correlated with mJOA at 3 months (r = −0.287, P < 0.001) and 24 months (r = −0.38, P < 0.001).…”

Section: Discussionmentioning

confidence: 95%

“…This is generally consistent with prior literature showing similar rates of satisfaction, including 77% satisfied after 2 years in a cohort of 288 patients and 80% satisfied after an average follow-up of 9.3 years in a cohort of 69 patients. 10,36 Patient satisfaction has remained a crucial postoperative outcome of interest even among the wide array of available patient-reported outcomes (PROs). As a direct measure of the patients' perception of the care they received, satisfaction is a particularly subjective, complex amalgamation of many factors including baseline characteristics, inter-personal relationships, and expectations going into surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The limited literature surrounding this question has established a positive correlation between change in overall mJOA score and standardized measures of patient satisfaction in patients with CSM. [9][10][11] However, these studies did not segregate the individual associations between upper and lower limb mJOA scores and satisfaction, and there exist few published comparisons of any elements of upper versus lower limb presentation amongst CSM patients. A study by Funaba et al focusing on radiological factors has associated neck stiffness and anterior spondylolisthesis with patients who express more severe lower extremity dysfunction than upper.…”

mentioning

confidence: 99%

“…Few studies have examined how functional improvement directly relates to patient satisfaction, another key postoperative measure. The limited literature surrounding this question has established a positive correlation between change in overall mJOA score and standardized measures of patient satisfaction in patients with CSM 9–11 . However, these studies did not segregate the individual associations between upper and lower limb mJOA scores and satisfaction, and there exist few published comparisons of any elements of upper versus lower limb presentation amongst CSM patients.…”

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confidence: 99%

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Is Upper Extremity or Lower Extremity Function More Important for Patient Satisfaction? An Analysis of 24-Month Outcomes from the QOD Cervical Spondylotic Myelopathy Cohort

Yang,

Mummaneni,

Chou

et al. 2024

Clinical Spine Surgery

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Study Design: Retrospective analysis of a prospective, multicenter registry. Objective: To assess whether upper or lower limb mJOA improvement more strongly associates with patient satisfaction after surgery for cervical spondylotic myelopathy (CSM). Summary of Background Data: The modified Japanese Orthopaedic Association (mJOA) is commonly used to assess functional status in patients with CSM. Patients present with upper and/or lower extremity dysfunction, and it is unclear whether improvement in one and/or both symptoms drives postoperative patient satisfaction. Methods: This study utilizes the prospective Quality Outcomes Database (QOD) CSM data set. Clinical outcomes included mJOA and North American Spine Society (NASS) satisfaction. The upper limb mJOA score was defined as upper motor plus sensory mJOA, and the lower limb mJOA as lower motor plus sensory mJOA. Ordered logistic regression was used to determine whether upper or lower limb mJOA was more closely associated with NASS satisfaction, adjusting for other covariates. Results: Overall, 1141 patients were enrolled in the QOD CSM cohort. In all, 780 had both preoperative and 24-month mJOA scores, met inclusion criteria, and were included for analysis. The baseline mJOA was 12.1±2.7, and postoperatively, 85.6% would undergo surgery again (NASS 1 or 2, satisfied). Patients exhibited mean improvement in both upper (baseline:3.9±1.4 vs. 24 mo:5.0±1.1, P<0.001) and lower limb mJOA (baseline:3.9±1.4 vs. 24 mon:4.5±1.5, P<0.001); however, the 24-month change in the upper limb mJOA was greater (upper:1.1±1.6 vs. lower:0.6±1.6, P<0.001). Across 24-month NASS satisfaction, the baseline upper and lower limb mJOA scores were similar (pupper=0.28, plower=0.092). However, as satisfaction decreased, the 24-month change in upper and lower limb mJOA decreased as well (pupper<0.001, plower<0.001). Patients with NASS scores of 4 (lowest satisfaction) did not demonstrate significant differences from baseline in upper or lower limb mJOA (P>0.05). In ordered logistic regression, NASS satisfaction was independently associated with upper limb mJOA improvement (OR=0.81; 95% CI: 0.68-0.97; P=0.019) but not lower limb mJOA improvement (OR=0.84; 95% CI: 0.70-1.0; P=0.054). Conclusions: As the magnitude of upper and lower mJOA improvement decreased postoperatively, so too did patient satisfaction with surgical intervention. Upper limb mJOA improvement was a significant independent predictor of patient satisfaction, whereas lower limb mJOA improvement was not. These findings may aid preoperative counseling, stratified by patients’ upper and lower extremity treatment expectations. Level of Evidence: Level—III.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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