Clinical predictors of surgical selection for individuals with neck pain

Neck pain is one of the leading causes of disability in the United States. However, the nature of cervical spine surgery is multi-factorial and often based upon clinical opinions, leaving clinical indications still to be clearly defined.

To predict which clinical variables most influenced trends toward surgical or conservative management for individuals with neck pain.

Retrospective analysis on prospectively collected data.

Two-hundred seventy individuals participated in the study. A retrospective chart review was performed to identify qualifying participants. Variables captured during data collection included the following: patient demographic information, physical examination (e.g., neurologic examination), physical performance measures, patient-reported outcome measures (Numeric Pain Rating Scale and Neck Disability Index), and chronicity of symptoms. Group allocation was determined by referring physician's medical diagnosis. A forward step-wise multiple logistic regression analysis was used to develop a final predictor model with p < 0.05 considered significant.

The model showed older age (beta = 0.022; Exp(beta) = 1.022; p = 0.037), longer chronicity of symptoms (beta = 0.000; Exp(beta) = 1.000; p = 0.012), and greater neck disability (beta = 0.027; Exp(beta) = 1.028; p < 0.001) were significant predictors of the operative group. Most notably, patients with a positive neurologic examination were almost four times more likely to be referred to surgery (beta = 1.368; Exp(beta) = 3.927; p < 0.001).

In general neck pain patients, older age, longer chronicity of symptoms, greater disability, and a positive neuro exam are clinical predictors of surgical selection, with positive neuro exam increasing the likelihood of surgery four-fold.