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Research ArticleArticle

Arm Pain Versus Neck Pain: A Novel Ratio as a Predictor of Post-Operative Clinical Outcomes in Cervical Radiculopathy Patients

PETER G. PASSIAS, SAQIB HASAN, KRIS RADCLIFF, ROBERT ISAACS, KRISTINA BIANCO, CYRUS M. JALAI, GREGORY W. POORMAN, NANCY J. WORLEY, SAMANTHA R. HORN, ANTHONY BONIELLO, PETER L. ZHOU, PAUL M. ARNOLD, PATRICK HSIEH, ALEXANDER R. VACCARO and MICHAEL C. GERLING
International Journal of Spine Surgery October 2018, 12 (5) 629-637; DOI: https://doi.org/10.14444/5078
PETER G. PASSIAS
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
MD
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SAQIB HASAN
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
MD
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KRIS RADCLIFF
2Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
MD
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ROBERT ISAACS
3Division of Neurosurgery, Duke University, Durham, North Carolina
MD
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KRISTINA BIANCO
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
BA
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CYRUS M. JALAI
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
BA
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GREGORY W. POORMAN
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
BA
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NANCY J. WORLEY
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
BA
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SAMANTHA R. HORN
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
BA
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ANTHONY BONIELLO
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
BA
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PETER L. ZHOU
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
BA
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PAUL M. ARNOLD
4Neurosurgery, University of Kansas Hospital, Kansas City, Kansas
MD
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PATRICK HSIEH
5Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, California
MD
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ALEXANDER R. VACCARO
2Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
MD
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MICHAEL C. GERLING
1Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
MD
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ABSTRACT

Background: Informed patient selection and counseling is key in improving surgical outcomes. Understanding the impact that certain baseline variables can have on postoperative outcomes is essential in optimizing treatment for certain symptoms, such as radiculopathy from cervical spine pathologies. The aim was to identify baseline characteristics that were related to improved or worsened postoperative outcomes for patients undergoing surgery for cervical spine radiculopathic pain.

Methods: Retrospective review of prospectively collected data. Patient Sample: Surgical cervical spine patients with a diagnosis classification of “degenerative.” Diagnoses included in the “degenerative” category were those that caused radiculopathy: cervical disc herniation, cervical stenosis, and cervical spondylosis without myelopathy. Baseline variables considered as predictors were: (1) age, (2) body mass index (BMI), (3) gender, (4) history of cervical spine surgery, (5) baseline Neck Disability Index (NDI) score, (6) baseline SF-36 Physical Component Summary (PCS) scores, (7) baseline SF-36 Mental Component Summary (MCS) scores, (8) Visual Analog Scale (VAS) Arm score, and (9) VAS Neck. Outcome Measures: Improvement in NDI (≥50%), VAS Arm/Neck (≥50%), SF-36 PCS/MCS (≥10%) scores at 2-years postoperative. An arm-to-neck ratio (ANR) was also generated from baseline VAS scores. Univariate and multivariate analyses evaluated predictors for 2-year postoperative outcome improvements, controlling for surgical complications and technique.

Results: Three hundred ninety-eight patients were included. Patients with ANR ≤ 1 (n = 214) were less likely to reach improvements in 2-year NDI (30.0% vs 39.2%, P = .050) and SF-36 PCS (42.4% vs 53.5%, P = .025). Multivariate analysis for neck disability revealed higher baseline SF-36 PCS (odds ratio [OR] 1.053) and MCS (OR 1.028) were associated with over 50% improvements. Higher baseline NDI were reduced odds of postoperative neck pain improvement (OR 0.958). Arm pain greater than neck pain at baseline was associated with both increased odds of postoperative arm pain improvement (OR 1.707) and SF36 PCS improvement (OR 1.495).

Conclusions: This study identified specific symptom locations and health-related quality of life (HRQL) scores, which were associated with postoperative pain and disability improvement. In particular, baseline arm pain greater than neck pain was determined to have the greatest impact on whether patients met at least 50% improvement in their upper body pain score. These findings are important for clinicians to optimize patient outcomes through effective preoperative counseling.

  • arm neck ratio
  • radiculopathy
  • cervical spine
  • neck pain
  • arm pain

Footnotes

  • Disclosures and COI: Dr. Passias reports consultancy for Medicrea and SpineWave, speaking/teaching arrangements from Zimmer-Biomet, and grant from CSRS, all outside the submitted work. All other authors have no conflicts of interest to report. Institutional Review Board (IRB) approval was obtained from each contributing center prior to study initiation.

  • ©International Society for the Advancement of Spine Surgery
  • Copyright © 2018 ISASS - This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery
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Arm Pain Versus Neck Pain: A Novel Ratio as a Predictor of Post-Operative Clinical Outcomes in Cervical Radiculopathy Patients
PETER G. PASSIAS, SAQIB HASAN, KRIS RADCLIFF, ROBERT ISAACS, KRISTINA BIANCO, CYRUS M. JALAI, GREGORY W. POORMAN, NANCY J. WORLEY, SAMANTHA R. HORN, ANTHONY BONIELLO, PETER L. ZHOU, PAUL M. ARNOLD, PATRICK HSIEH, ALEXANDER R. VACCARO, MICHAEL C. GERLING
International Journal of Spine Surgery Oct 2018, 12 (5) 629-637; DOI: 10.14444/5078

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Arm Pain Versus Neck Pain: A Novel Ratio as a Predictor of Post-Operative Clinical Outcomes in Cervical Radiculopathy Patients
PETER G. PASSIAS, SAQIB HASAN, KRIS RADCLIFF, ROBERT ISAACS, KRISTINA BIANCO, CYRUS M. JALAI, GREGORY W. POORMAN, NANCY J. WORLEY, SAMANTHA R. HORN, ANTHONY BONIELLO, PETER L. ZHOU, PAUL M. ARNOLD, PATRICK HSIEH, ALEXANDER R. VACCARO, MICHAEL C. GERLING
International Journal of Spine Surgery Oct 2018, 12 (5) 629-637; DOI: 10.14444/5078
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Keywords

  • arm neck ratio
  • radiculopathy
  • cervical spine
  • neck pain
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