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Quality of life outcomes following surgery for patients with coexistent cervical stenosis and multiple sclerosis

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Abstract

Purpose

To investigate the quality of life outcomes following surgical treatment of patients with coexisting multiple sclerosis (MS) and cervical stenosis with associated myelopathy (CS).

Methods

A retrospective review of the medical records and of prospectively acquired quality of life (QOL) data was performed for all patients with symptoms of myelopathy and coexisting diagnoses of MS and CS that underwent cervical decompression surgery between 2008 and 2011. The study population was matched (1:4) to a control cohort of patients that did not have MS but presented with similar myelopathic symptoms due to cervical stenosis, were of the same age and gender, and underwent the same cervical decompression procedure within the same year.

Results

Sixty-five patients were reviewed, including 13 in the MS group and 52 in the control group that were followed for an average of 22 and 18 months, respectively. Whereas patients in the MS cohort remained at a Quality-Adjusted Life-Year (QALY) gain of 0.51 both pre- and post-operatively (p = 0.96), patients in the matched control cohort improved from a preoperative QALY of 0.50 to a postoperative QALY of 0.64 (p < 0.0001). The latter represents an improvement that exceeds the minimum clinically important difference. Overall, 70 % of patients in the control group experienced an improvement in QALY, compared to only 54 % in the MS group (p = 0.4).

Conclusion

Patients in the control cohort had clinically and statistically significant improvements in QALY outcomes. Those in the MS cohort averaged no change in QALY. However, only a minority of MS/CS patients had worsening QALY following surgery, and as such surgery may still be considered for these patients. It is imperative that there are preoperative discussions with the MS/CS patient regarding the likelihood that surgery will only provide limited, if any, improvements in QOL.

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Conflict of interest

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Author information

Authors and Affiliations

  1. Departments of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA

    Daniel Lubelski, Edward C. Benzel & Thomas E. Mroz

  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Matthew D. Alvin

  3. Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA

    Michael Silverstein

  4. Department of Neurosurgery, Suleyman Demirel University School of Medicine, Isparta, Turkey

    Nilgun Senol

  5. Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Kalil G. Abdullah

  6. Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA

    Daniel Lubelski, Edward C. Benzel & Thomas E. Mroz

  7. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

    Daniel Lubelski, Edward C. Benzel & Thomas E. Mroz

Authors
  1. Daniel Lubelski
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  2. Matthew D. Alvin
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  3. Michael Silverstein
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  4. Nilgun Senol
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  5. Kalil G. Abdullah
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  6. Edward C. Benzel
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  7. Thomas E. Mroz
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Corresponding author

Correspondence to Daniel Lubelski.

Additional information

No grants, technical or corporate support were received in conducting this study or writing this manuscript. IRB approval (Study # 11-285) was obtained prior to start of study.

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Lubelski, D., Alvin, M.D., Silverstein, M. et al. Quality of life outcomes following surgery for patients with coexistent cervical stenosis and multiple sclerosis. Eur Spine J 23, 1699–1704 (2014). https://doi.org/10.1007/s00586-014-3331-x

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  • DOI: https://doi.org/10.1007/s00586-014-3331-x

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