Fulfillment of patient expectations after surgery for degenerative cervical myelopathy. A retrospective analysis of prospectively collected data from the multicenter Canadian Surgical Spine Registry (CSORN).

Abstract

While abundant literature supports the clinical benefits of surgery for degenerative cervical myelopathy (DCM), limited evidence exists regarding the extent to which patients' pre-operative expectations are met postoperatively. This study primarily aimed to report the fulfillment of pre-operative expectations 12 months post-surgery. Secondary objectives included identifying predictors of expectation fulfillment and overall patient satisfaction following surgical intervention for DCM. We conducted a multicenter analysis of spine surgery patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN)-DCM prospective cohort. Patients who underwent surgical treatment for DCM between April 2015 and September 2022 were included. Patients completed a pre-operative 11-domain expectation questionnaire, quantifying their expected clinical changes in each domain. At 12 months postoperatively, patients reported the extent to which their pre-operative expectations were met in each domain, as well as their overall satisfaction with surgical outcomes. Multivariable logistic regression models were employed to identify and validate variables associated with expectation fulfillment and satisfaction. Among the 490 patients included, 49.2% had all their expectations met and 3.7% had none of their expectations met. The expectations that were most frequently met were prevention of neurological decline (87.5%) and maintaining of independence (86.7%). There were 83% of patients who were satisfied at 12 months. Multivariable logistic regression identified pre-operative variables (not smoking, not using pain medication pre-surgery, having lower levels of depressive symptoms (PHQ-8)), surgical variables (anterior and posterior non-fusion approaches), the absence of peri-operative adverse events and improvement in pain and Health-Related Quality of life scores at 12 months (NRS neck-pain, SF12 PCS and SF-12 MCS scores) as predictors of expectation fulfillment. Improvement in the mJOA score was not a predictor of expectation fulfillment. Having pre-operative expectations met was a strong predictor of being satisfied with the surgery (p < 0.01). The majority of patients undergoing surgery for degenerative cervical myelopathy (DCM) reported satisfaction with their outcomes, with nearly half experiencing complete fulfillment of their pre-operative expectations. Importantly, we identified nine independent predictors of expectation fulfillment, which in turn emerged as a strong determinant of overall patient satisfaction. These findings highlight the critical role of personalized pre-operative counseling in optimizing surgical outcomes. By aligning patients' expectations with realistic goals through individualized care strategies, clinicians may significantly enhance patient satisfaction and the perceived value of surgical intervention in DCM.