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Preoperative psychological health impacts pain and disability outcomes following anterior cervical discectomy and fusion for cervical radiculopathy
This study aimed to estimate the effects of preoperative psychological health on postoperative outcomes in patients undergoing surgery for cervical spondylotic radiculopathy. This retrospective cohort study included data from patients enrolled in the Canadian Spine Outcomes and Research Network who underwent anterior cervical discectomy and fusion for radiculopathy. Preoperative psychological health was measured with the Patient Health Questionnaire-8 (PHQ-8), and depression and severe psychological symptomology were measured with the Mental Component Score of the Short Form Survey-12 (MCS). Surgical outcomes comprised trajectory subgroups for neck pain and arm pain (numeric rating scales) and disability (neck disability index) measured preoperatively and 3, 12, and 24 months after surgery. For each outcome, patients were dichotomized as following either a poor or a fair-to-excellent trajectory. Average treatment effects were estimated with doubly robust propensity score models using inverse probability of treatment weights accounting for multiple confounders. We included data from 352 patients (43.8% female). Approximately half (52.1%) of patients were identified as depressed based on the PHQ-8, while 61.8% and 33.1% were classified as experiencing depression or severe psychological symptomology, respectively, on the MCS. In fully adjusted models, patients with PHQ-8-measured depression were at increased risk of poor postoperative outcomes for disability (risk ratio[95% CI] = 6.73[1.85 to 24.45]) and neck pain (RR[95% CI] = 1.90[1.09 to 3.32]). Patients with MCS-measured depression were at elevated risk of a poor disability outcome (RR[95% CI] = 2.77[1.30 to 5.90]). Patients reporting severe psychological symptomatology had an increased likelihood of poor disability, neck pain, and arm pain outcomes (RR[95% CI] = 1.82 [1.17 to 2.82] to 2.84[1.58 to 5.09]). These findings highlight the high prevalence of negative psychological features and their impacts on neck surgery outcomes. Future research should prioritize the development and evaluation of preoperative interventions to optimize psychological well-being and improve surgical outcomes in this population.
Journal Article
Probabilistic Approaches to Coastal Risk Decision-Making Under Future Sea Level Projections
Coastal communities are increasingly threatened by flooding from climate change-induced sea level rise and potential increases in storminess. Informed decisions on risk and resilience related to flood risk need to be made, but the assessment process is complex. It is difficult to bring all of the climate science and sea level rise projections to decision-making, and as a result, decisions are made without a real understanding of the uncertainties involved, a problem magnified the further projections go into the future (Figure 1).
Journal Article
Effectiveness of Surgical Decompression in Patients With Degenerative Cervical Myelopathy: Results of the Canadian Prospective Multicenter Study
Abstract
BACKGROUND
Conflicting evidence exists regarding the effectiveness of surgery for degenerative cervical myelopathy (DCM), particularly in mild DCM.
OBJECTIVE
To prospectively evaluate the impact of surgery on patient-reported outcomes in patients with mild (modified Japanese Orthopaedic Association [mJOA] ≥ 15), moderate (mJOA 12-14), and severe (mJOA < 12) DCM.
METHODS
Prospective, multicenter cohort study of patients with DCM who underwent surgery between 2015 and 2019 and completed 1-yr follow-up. Outcome measures (mJOA, Neck Disability Index [NDI], EuroQol-5D [EQ-5D], Short Form [SF-12] Physical Component Score [PCS]/Mental Component Score [MCS], numeric rating scale [NRS] neck, and arm pain) were assessed at 3 and 12 mo postoperatively and compared to baseline, stratified by DCM severity. Changes in outcome measures that were statistically significant (P < .05) and met their respective minimum clinically important differences (MCIDs) were deemed clinically meaningful. Responder analysis was performed to compare the proportion of patients between DCM severity groups who met the MCID for each outcome measure.
RESULTS
The cohort comprised 391 patients: 110 mild, 163 moderate, and 118 severe. At 12 mo after surgery, severe DCM patients experienced significant improvements in all outcome measures; moderate DCM patients improved in mJOA, NDI, EQ-5D, and PCS; mild DCM patients improved in EQ-5D and PCS. There was no significant difference between severity groups in the proportion of patients reaching MCID at 12 mo after surgery for any outcome measure, except NDI.
CONCLUSION
At 12 mo after surgery, patients with mild, moderate, and severe DCM all demonstrated improved outcomes. Severe DCM patients experienced the greatest breadth of improvement, but the proportion of patients in each severity group achieving clinically meaningful changes did not differ significantly across most outcome measures.
Graphical Abstract
Graphical Abstract
Journal Article
Human plasma proteomic profile of clonal hematopoiesis
Plasma proteomic profiles associated with subclinical somatic mutations in blood cells may offer insights into downstream clinical consequences. Here we explore these patterns in clonal hematopoiesis of indeterminate potential (CHIP), which is linked to several cancer and non-cancer outcomes, including coronary artery disease (CAD). Among 61,833 participants (3881 with CHIP) from TOPMed and UK Biobank (UKB) with blood-based DNA sequencing and proteomic measurements (1,148 proteins by SomaScan in TOPMed and 2917 proteins by Olink in UKB), we identify 32 and 345 proteins from TOPMed and UKB, respectively, associated with CHIP and most prevalent driver genes (
DNMT3A
,
TET2
, and
ASXL1
). These associations show substantial heterogeneity by driver genes, sex, and race, and were enriched for immune response and inflammation pathways. Mendelian randomization in humans, coupled with ELISA in hematopoietic
Tet2
-/- vs wild-type mice validation, disentangle causal proteomic perturbations from
TET2
CHIP. Lastly, we identify plasma proteins shared between CHIP and CAD.
Somatic mutations in blood cells (CHIP) are linked to diseases like heart disease, but the mechanisms are unclear. Here, the authors show that different CHIP driver genes alter unique sets of plasma proteins, some of which are validated in mouse models.
Journal Article
Temporal analysis of complication rates of cervical spine surgery for degenerative spine disease between younger and older cohorts using the CSORN registry: Is age just a number?
Study designAn ambispective review of consecutive cervical spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) between January 2015 and September 2019.PurposeTo compare complication rates of degenerative cervical spine surgery over time between older (> 65) and younger age groups (< 65).Summary of background dataMore elderly people are having spinal surgery. Few studies have examined the temporal nature of complications of cervical spine surgery by patient age groups.MethodsAdverse events were collected prospectively using adverse event forms. Binary logistic regression analysis was utilized to assess associations between risk modifiers and adverse events at the intra-, peri-operative and 3 months post-surgery.ResultsOf the 761 patients studied (age < 65, n = 581 (76.3%) and 65 + n = 180 (23.7%), the intra-op adverse events were not significantly different; < 65 = 19 (3.3%) vs 65 + = 11 (6.1%), p < 0.087. Peri-operatively, the < 65 group had significantly lower percentage of adverse events (65yrs (11.2%) vs. 65 + = (26.1%), p < 0.001). There were no differences in rates of adverse events at 3 months post-surgery (< 65 = 39 (6.7%) vs. 65 + = 12 (6.7%), p < 0.983). Less blood loss (OR = 0.99, p < 0.010) and shorter length of hospital stay (OR = 0.97, p < 0.025) were associated with not having intra-op adverse events. Peri-operatively, > 1 operated level (OR = 1.77, p < 0.041), shorter length of hospital stay (OR = 0.86, p < 0.001) and being younger than 65 years (OR = 2.11, p < 0.006) were associated with not having adverse events.ConclusionFollowing degenerative cervical spine surgery, the older and younger age groups had significantly different complication rates at peri-operative time points, and the intra-operative and 3-month post-operative complication rates were similar in the groups.
Journal Article