Age as a predictor of patient-reported outcomes in anterior cervical discectomy and fusion: analysis of the Michigan Spine Surgery Improvement Collaborative

Document Type

Article

Publication Date

11-28-2025

Publication Title

Journal of neurosurgery. Spine

Keywords

Humans, Spinal Fusion, Male, Patient Reported Outcome Measures, Female, Diskectomy, Aged, Cervical Vertebrae, Middle Aged, Age Factors, Michigan, Adult, Treatment Outcome, Registries, Minimal Clinically Important Difference

Abstract

OBJECTIVE: Older patients are increasingly undergoing anterior cervical discectomy and fusion (ACDF). Although studies have examined complication rates in older patients, the correlation between age and achieving specific patient-reported outcomes (PROs) is lacking. The authors sought to determine whether older patients undergoing ACDF are independently associated with lower odds of achieving minimal clinically important difference (MCID) for pain and physical function.

METHODS: The authors queried the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry for patients who underwent 1- to 4-level ACDF (March 2014 to July 2019) for degenerative conditions. PROs were measured at baseline, 90 days, 1 year, and 2 years using the neck and arm numerical rating scale (NRS), Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), EQ-5D, and North American Spine Society (NASS) satisfaction index. Patients were divided into older (≥ 70 years old) versus younger (< 70 years) groups. The authors used univariate analysis to compare demographic characteristics, operative characteristics, and proportions that achieved MCID between the age groups.

RESULTS: This study included 7732 patients (6887 [89.1%] < 70 years old and 845 [10.9%] ≥ 70 years old). Unadjusted results demonstrated that older patients had a significantly higher rate of any complication within 90 days (26% vs 19%, p < 0.001), longer length of stay (2.6 days vs 1.7 days, p < 0.001), higher rates of MCID in neck NRS score at any time (76.9% vs 70.3%, p = 0.02) and at 90 days (71.3% vs 60.6%, p = 0.002), and lower rates of MCID in PROMIS-PF score at 1 year (52.7% vs 59.6%, p = 0.044) and 2 years (45.9% vs 57.7%, p = 0.002). Age was not independently associated with any PRO. Independent preoperative ambulation (OR 1.80, p < 0.001) and ambulation at postoperative day 0 (OR 1.25, p < 0.001) were independently associated with significantly increased odds of achieving MCID in PROMIS-PF score. Minor complications within 90 days (OR 0.67, p < 0.001) and lower baseline PROMIS-PF score (OR 0.89, p < 0.001) were independently associated with significantly decreased odds of achieving PROMIS-PF score. For the older subgroup, independent preoperative ambulation (OR 2.11, 95% CI 1.44-3.09, p < 0.001) had significantly increased odds of achieving MCID in PROMIS-PF score.

CONCLUSIONS: Unadjusted results demonstrated that older patients had significantly longer length of stay and complication rates within 90 days. Adjusted analyses demonstrated that advanced age was not independently associated with PROs in patients undergoing ACDF. However, independent early postoperative and preoperative ambulation were associated with significantly increased odds of improved PROs following ACDF.

Medical Subject Headings

Humans; Spinal Fusion; Male; Patient Reported Outcome Measures; Female; Diskectomy; Aged; Cervical Vertebrae; Middle Aged; Age Factors; Michigan; Adult; Treatment Outcome; Registries; Minimal Clinically Important Difference

PubMed ID

41343795

ePublication

ePub ahead of print

Volume

44

Issue

2

First Page

226

Last Page

234

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