Spine - 2026-08-01 - Journal Article; Comparative Study
Comparing those Most Satisfied Versus Least Satisfied Following Surgery for Cervical Spondylotic Myelopathy: Are there Differences in Baseline Characteristics?
Chan AK, Park C, Shaffrey CI, Gottfried ON, Than KD, Bisson EF, Williamson TL, Bydon M, Asher AL, Coric D, Potts EA, Foley KT, Wang MY, Fu KM, Virk MS, Knightly JJ, Meyer S, Park P, Upadhyaya C, Yen CP, Uribe JS, Tumialán LM, Turner J, Chou D, Haid RW, Mummaneni PV
Topics
Key Takeaway
In 699 CSM surgical patients, higher baseline quality of life (OR=4.0), anterior approach (OR=2.3), UE weakness as presenting symptom (OR=2.5), and symptom duration under 12 months (OR=1.6) were the strongest independent predictors of maximum postoperative satisfaction at 24 months.
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Summary
This post hoc analysis of the Quality Outcomes Database CSM registry compared baseline and surgical characteristics between the most satisfied (NASS 1, n=610, 87.3%) and least satisfied (NASS 4, n=89, 12.7%) patients at 24 months post-surgery. Multivariable logistic regression identified eight independent predictors of maximum satisfaction, with higher baseline QOL carrying the strongest association (OR=4.0). The least satisfied cohort showed no significant improvement in any PRO at 24 months, while the most satisfied cohort improved across all measured PROs.
Key Limitation
The binary comparison of satisfaction extremes (NASS 1 vs. 4) excludes 26% of the follow-up cohort with intermediate satisfaction scores, limiting generalizability of the predictive model to the full CSM surgical population.
Original Abstract
STUDY DESIGN
Post hoc analysis of prospectively-collected data.
OBJECTIVE
To identify factors predicting the most (and least) satisfaction following surgery for cervical spondylotic myelopathy (CSM).
SUMMARY OF BACKGROUND DATA
Patient satisfaction affects long-term outcomes after surgery but the preoperative factors that influence postoperative satisfaction have not been well studied in patients with CSM.
METHODS
We conducted a post hoc analysis of prospectively-collected data from the Quality Outcomes Database (QOD) CSM registry cohort. Baseline and surgical characteristics were compared for patients with CSM reporting the most [North American Spine Society Satisfaction Score (NASS) 1] and least (NASS 4) satisfaction 24 months postoperatively. A multivariable logistic regression model was constructed using backward stepwise elimination to determine significant predictors of most versus least satisfaction. Twenty-four-month patient-reported outcomes (PROs) were compared.
RESULTS
Overall, 1141 patients were prospectively enrolled with 948 (83.1%) reaching 24-month follow-up. Of these, 699 met prespecified inclusion criteria: 610 (87.3%) were most satisfied and 89 (12.7%) were least satisfied. Though there were mean improvements in all 24-month PROs for the most satisfied cohort ( P <0.001), there were no significant improvements in 24-month PROs for the least satisfied cohort ( P >0.05). Using multivariable logistic regression modeling, a preoperative symptom of upper extremity weakness (OR=2.5, P =0.003), subjective myelopathy (OR=2.0, P =0.04), absence of numbness complaints (OR=2.2, P =0.003), symptom duration under 12 months (OR=1.6, P =0.047), Caucasian race (OR=2.3, P =0.001), participation in activities outside of the home (OR=2.0, P =0.04), anterior approach (OR=2.3, P <0.001), and higher baseline quality of life (OR=4.0, P =0.01) were predictive of the most satisfaction.
CONCLUSION
Compared with the least satisfied, those most satisfied following surgery for CSM more often had a preoperative symptom of arm weakness, subjective myelopathy, the absence of numbness complaints, symptom duration under 12 months, higher baseline quality of life, and participation in activities outside of the home. Compared with a posterior approach, an anterior approach was associated with the most satisfaction. Taken together, early surgical treatment--before myelopathic symptoms significantly impact one's quality of life--may be considered to optimize patient satisfaction following CSM surgery.