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European Spine Journal
Published in: European Spine Journal 8/2014

01-08-2014 | Original Article

Quality of life outcomes following surgery for patients with coexistent cervical stenosis and multiple sclerosis

Authors: Daniel Lubelski, Matthew D. Alvin, Michael Silverstein, Nilgun Senol, Kalil G. Abdullah, Edward C. Benzel, Thomas E. Mroz

Published in: European Spine Journal | Issue 8/2014

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Abstract

Purpose

To investigate the quality of life outcomes following surgical treatment of patients with coexisting multiple sclerosis (MS) and cervical stenosis with associated myelopathy (CS).

Methods

A retrospective review of the medical records and of prospectively acquired quality of life (QOL) data was performed for all patients with symptoms of myelopathy and coexisting diagnoses of MS and CS that underwent cervical decompression surgery between 2008 and 2011. The study population was matched (1:4) to a control cohort of patients that did not have MS but presented with similar myelopathic symptoms due to cervical stenosis, were of the same age and gender, and underwent the same cervical decompression procedure within the same year.

Results

Sixty-five patients were reviewed, including 13 in the MS group and 52 in the control group that were followed for an average of 22 and 18 months, respectively. Whereas patients in the MS cohort remained at a Quality-Adjusted Life-Year (QALY) gain of 0.51 both pre- and post-operatively (p = 0.96), patients in the matched control cohort improved from a preoperative QALY of 0.50 to a postoperative QALY of 0.64 (p < 0.0001). The latter represents an improvement that exceeds the minimum clinically important difference. Overall, 70 % of patients in the control group experienced an improvement in QALY, compared to only 54 % in the MS group (p = 0.4).

Conclusion

Patients in the control cohort had clinically and statistically significant improvements in QALY outcomes. Those in the MS cohort averaged no change in QALY. However, only a minority of MS/CS patients had worsening QALY following surgery, and as such surgery may still be considered for these patients. It is imperative that there are preoperative discussions with the MS/CS patient regarding the likelihood that surgery will only provide limited, if any, improvements in QOL.
Literature
1.
Courtney AM, Treadaway K, Remington G, Frohman E (2009) Multiple sclerosis. Med Clin N Am 93:451–476PubMedCrossRef
2.
Rudick RA, Cohen JA, Weinstock-Guttman B, Kinkel RP, Ransohoff RM (1997) Management of multiple sclerosis. N Engl J Med 337:1604–1611PubMedCrossRef
3.
Naci H, Fleurence R, Birt J, Duhig A (2010) Economic burden of multiple sclerosis: a systematic review of the literature. Pharmacoeconomics 28:363–379PubMedCrossRef
4.
Burden of illness of multiple sclerosis (1998) Part I: cost of illness. The Canadian Burden of Illness Study Group. Can J Neurol Sci 25:23–30
5.
Edwards CC 2nd, Riew KD, Anderson PA, Hilibrand AS, Vaccaro AF (2003) Cervical myelopathy. current diagnostic and treatment strategies. Spine J 3:68–81PubMedCrossRef
6.
Klineberg E (2010) Cervical spondylotic myelopathy: a review of the evidence. Orthop Clin N Am 41:193–202CrossRef
7.
8.
9.
Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG (2000) Multiple sclerosis. N Engl J Med 343:938–952PubMedCrossRef
10.
Brain R, Wilkinson M (1957) The association of cervical spondylosis and disseminated sclerosis. Brain 80:456–478PubMedCrossRef
11.
Burgerman R et al (1992) The association of cervical spondylosis and multiple sclerosis. Surg Neurol 38:265–270PubMedCrossRef
12.
Young WF, Weaver M, Mishra B (1999) Surgical outcome in patients with coexisting multiple sclerosis and spondylosis. Acta Neurol Scand 100:84–87PubMedCrossRef
13.
Bashir K, Cai CY, Moore TA 2nd, Whitaker JN, Hadley MN (2000) Surgery for cervical spinal cord compression in patients with multiple sclerosis. Neurosurgery 47:637–642 (discussion 642–643)PubMed
14.
Arnold PM, Baek PN, Bernardi RJ, Luck EA, Larson SJ (1997) Surgical management of nontuberculous thoracic and lumbar vertebral osteomyelitis: report of 33 cases. Surg Neurol 47:551–561PubMedCrossRef
15.
Harris PA et al (2009) Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381PubMedCentralPubMedCrossRef
16.
Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100PubMedCrossRef
17.
Jansson K-A, Németh G, Granath F, Jönsson B, Blomqvist P (2005) Health-related quality of life in patients before and after surgery for a herniated lumbar disc. J Bone Joint Surg Br 87:959–964PubMedCrossRef
18.
Hansson TH, Hansson EK (2000) The effects of common medical interventions on pain, back function, and work resumption in patients with chronic low back pain: a prospective 2-year cohort study in six countries. Spine 25:3055–3064PubMedCrossRef
19.
McDonough CM et al (2005) Comparison of EQ-5D, HUI, and SF-36-derived societal health state values among spine patient outcomes research trial (SPORT) participants. Qual Life Res 14:1321–1332PubMedCentralPubMedCrossRef
20.
The EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16(3):199–208
21.
McDonough CM et al (2011) A longitudinal comparison of 5 preference-weighted health state classification systems in persons with intervertebral disk herniation. Med Decis Making 31:270–280PubMedCentralPubMedCrossRef
22.
Kepler CK et al (2012) Cost-utility analysis in spine care: a systematic review. Spine J 12:676–690PubMedCrossRef
23.
Johnson JA, Coons SJ, Ergo A, Szava-Kovats G (1998) Valuation of EuroQOL (EQ-5D) health states in an adult US sample. Pharmacoeconomics 13:421–433PubMedCrossRef
24.
Badia X et al (2001) Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit. Intensive Care Med 27:1901–1907PubMedCrossRef
25.
Parker SL, Godil SS, Shau DN, Mendenhall SK, McGirt MJ (2013) Assessment of the minimum clinically important difference in pain, disability, and quality of life after anterior cervical discectomy and fusion: clinical article. J Neurosurg Spine 18:154–160PubMedCrossRef
26.
Noonan CW, Kathman SJ, White MC (2002) Prevalence estimates for MS in the United States and evidence of an increasing trend for women. Neurology 58:136–138PubMedCrossRef
27.
28.
29.
Alschuler KN, Ehde DM, Jensen MP (2013) The co-occurrence of pain and depression in adults with multiple sclerosis. Rehabil Psychol 58:217–221PubMedCrossRef
30.
31.
Mitchell AJ, Benito-León J, González J-MM, Rivera-Navarro J (2005) Quality of life and its assessment in multiple sclerosis: integrating physical and psychological components of wellbeing. Lancet Neurol 4:556–566PubMedCrossRef
32.
Bermejo PE, Oreja-Guevara C, Díez-Tejedor E (2010) Pain in multiple sclerosis: prevalence, mechanisms, types and treatment. Rev Neurol 50:101–108PubMed
33.
Telci Aslan (2012) E. & Karaduman, A. Effects of three different conservative treatments on pain, disability, quality of life, and mood in patients with cervical spondylosis. Rheumatol Int 32:1033–1040CrossRef
34.
35.
Glanz BI et al (2012) Work productivity in relapsing multiple sclerosis: associations with disability, depression, fatigue, anxiety, cognition, and health-related quality of life. Value Health 15:1029–1035PubMedCrossRef
36.
Owens GM, Olvey EL, Skrepnek GH, Pill MW (2013) Perspectives for managed care organizations on the burden of multiple sclerosis and the cost-benefits of disease-modifying therapies. J Manag Care Pharm 19:S41–S53PubMed
37.
38.
Fehlings MG et al (2012) Is surgery for cervical spondylotic myelopathy cost-effective? A cost-utility analysis based on data from the AOSpine North America prospective CSM study. J Neurosurg Spine 17:89–93PubMed
39.
Nortvedt MW, Riise T, Myhr K-M, Nyland HI (1999) Quality of life in multiple sclerosis measuring the disease effects more broadly. Neurology 53:1098–1103PubMedCrossRef
40.
Benito-León J, Morales JM, Rivera-Navarro J, Mitchell A (2003) A review about the impact of multiple sclerosis on health-related quality of life. Disabil Rehabil 25:1291–1303PubMedCrossRef
41.
Benito-León J, Mitchell AJ, Rivera-Navarro J, Morales-González JM (2013) Impaired health-related quality of life predicts progression of disability in multiple sclerosis. Eur J Neurol 20:79–86PubMedCrossRef
Metadata
Title
Quality of life outcomes following surgery for patients with coexistent cervical stenosis and multiple sclerosis
Authors
Daniel Lubelski
Matthew D. Alvin
Michael Silverstein
Nilgun Senol
Kalil G. Abdullah
Edward C. Benzel
Thomas E. Mroz
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 8/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3331-x

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