High Preoperative Expectations May Not Need to be Feared

Retrospective study design.

Evaluate correlations between preoperative expectations for pain improvement and 12-month functional outcomes and satisfaction following 1-2-level primary anterior cervical surgery.

Limited data exists evaluating correlations between patients' preoperative expectations for pain relief and subsequent functional and satisfaction outcomes following primary anterior cervical surgery. Understanding correlations between expectations and outcomes may help identify patients most likely to benefit from surgery.

Patients who underwent 1-2-level primary anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty for degenerative disease between 2016 and 2021 were included. All patients had 12-month Neck Disability Index (NDI) data. Preoperative expectations for pain relief were collected at the initial clinic visit using 5-point Likert scales. Preoperative and 12-month postoperative satisfaction were recorded using 7-point Likert scales. Covariates include age, sex, procedure type, smoking status, opioid use, worker's compensation/litigation, body mass index, and indication (radiculopathy vs. myelopathy). Linear regression models were constructed to assess the 12-month NDI change score versus pain relief expectations. Additional regression models assessed expectations versus achievement of minimum clinically important difference at 3 and 12 months and satisfaction at 12 months.

198 ACDF (56.1% female, median age 57) and 52 CDR patients (55.8% female, median age 51) were included. Regression models found no significant correlations between pain relief expectations and degree of NDI score improvement at the 12-month postoperative timepoint or minimum clinically important difference achievement at the 3- and 12-month postoperative timepoints. There was no association between preoperative expectations and 12-month satisfaction. However, greater preoperative dissatisfaction was significantly associated with greater 12-month improvement in NDI score.

Preoperative pain relief expectations were not associated with functional outcomes or satisfaction following 1-2 level primary ACDF or CDR at 12-month follow-up. Patients' dissatisfaction with their preoperative spinal condition was significantly associated with greater 12-month NDI improvement. Assessing preoperative satisfaction may help identify those most likely to benefit from surgery.