Discrepancy Between Global-Specific and Disease-Specific Outcome Measures Following Cervical Spine Surgery

STUDY DESIGN: Retrospective review of a prospectively collected multisurgeon registry. OBJECTIVE: To determine the correlation between patient-perceived changes in health and patient-reported outcome measures (PROMs) commonly used in cervical spine surgery. SUMMARY OF BACKGROUND DATA: Recently, there has been a growing focus on PROMs as important metrics in cervical spine surgery. However, there is little data on how these PROMs correlate with changes in patients' overall perception of health status. METHODS: Consecutive patients who underwent cervical disc replacement (CDR) or anterior cervical discectomy and fusion (ACDF) from 2017 to 2023 were included. The correlation between the Global Rating Change (GRC) questionnaire, a 5-item Likert Scale, and changes in PROMs (Neck Disability Index [NDI], Visual Analogue Scale [VAS] for neck and arm pain, Short-Form 12 [SF-12 PCS/MCS] and PROMIS physical function [PROMIS-PF]) was assessed using Spearman rank correlation coefficients. RESULTS: Three hundred sixteen patients (109 CDRs, 207 ACDFs) were available for analysis. Most patients in each group described their cervical spine-related health as "slightly better" or "much better" at each postoperative follow-up visit compared with preoperatively and the previous visit. In the CDR cohort, change in PROMs from preoperatively showed a statistically significant but moderate correlation with GRC for multiple PROMs, but change in PROMs from the previous visit did not show any significant correlations with GRC. In the ACDF cohort, change in PROMs from preoperatively were not significantly correlated with GRC, and change in PROMs from the prior visit showed a moderate correlation at one time-point each for NDI and VAS neck, with no other significant correlations. CONCLUSIONS: PROMs commonly utilized in cervical spine surgery demonstrated few statistically significant moderate-strength correlations with patient-perceived changes in health. These findings suggest that commonly used PROMs may not adequately assess changes in health that are relevant to patients undergoing cervical spine surgery. LEVEL OF EVIDENCE: Level III.