Establishing Maximal Medical Improvement Following Anterior Cervical Discectomy and Fusion
Benjamin Khechen, BA1 ; Dil V. Patel, BS1; Anirudh K. Gowd, BS1; Mundeep S. Bawa, BA1; Harmeet S. Bawa, BA1; Jordan A. Guntin, BS1; Sailee S. Karmarkar, BS1;
Joseph N. Liu, MD1; Kern Singh, MD1,2
1Department of Orthopaedic Surgery, Rush University Medical Center2Professor, Co-Director of the Minimally Invasive Spine Institute at Rush University Medical Center;
Founder and President, Minimally Invasive Spine Study Group
Disclosures
Benjamin Khechen, Dil V. Patel, Anirudh K. Gowd, Mundeep S. Bawa, Harmeet S.
Bawa, Jordan A. Guntin, Sailee S. Karmarkar, Joseph N. Liu – Nothing to disclose
Kern Singh, MD
• Board Membership – Vital 5 LLC, Avaz Surgical LLC• Consultant – Depuy, Zimmer, Stryker• Royalties – Zimmer, Stryker, Pioneer, Lippincott Williams and Wilkins,
Thieme, Jaypee Publishing, Slack Publishing
• Grants – Cervical Spine Research Society
Background and Purpose
• The identification of a time point at which patients reach maximal medical improvement (MMI) allows providers to understand postoperative requirements and manage expectations of surgical patients
• To identify the time point at which patients undergoing primary, single-level anterior cervical discectomy and fusion (ACDF) can be considered to have reached MMI.
Methodology
● Retrospective review of a prospectively-maintained database
● 69 patients that underwent a primary, single-level ACDF for degenerative pathology from 2014 to 2017
Methodology
• Variables Analyzed• Patient demographics• Patient-Reported Outcomes
(PROs)■ Neck Disability Index
(NDI)
• Statistical Analyses• Pearson chi-square• Multivariate linear regression• Distribution-based MCID• Nonparametric receiver
operating characteristic (ROC) curve
• Kaplan-Meier survival analysis• Cox regression
Results
Patient demographics and baseline characteristics
Results
NDI improvements in ACDF patients ranging from preoperative to 12-months postoperatively
Results
Over 95% of patients reach MCID for NDI at 6 months
Discussion
● 95.7% achieved MCID by 6 months, allowing MMI to be established at this point.
Limitations
• Incomplete survey data beyond 1-year limited analysis of detecting
further improvement in NDI
• Other patient-reported outcomes, such as pain scores, were not
evaluated during this investigation
Conclusions
• The majority of patients (62.7%) achieved MCID by 6-weeks
• As over 95% of patients achieved MCID by 6-months postoperatively, this time point was determined to represent MMI
• Future outcome reporting in patients undergoing ACDF should include follow-up to 6 months postoperatively
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