Anterior Cervical Discectomy and Fusion Results in Clinically Significant Improvements in Patients With Preoperative Sleep Difficulties

Article Figures & Data

Table 1

The Patient Health Questionnaire-9.

Over the past 2 weeks, how often have you been bothered by any of the following roblems?	Not At All	Several Days	More Than Half the Days	Nearly Every Day
1. Little interest or pleasure in doing things	0	1	2	3
2. Feeling down, depressed, or hopeless	0	1	2	3
3. Trouble falling asleep, staying asleep, or sleeping too much	0	1	2	3
4. Feeling tired or having little energy	0	1	2	3
5. Poor appetite or overeating	0	1	2	3
6. Feeling bad about yourself—or that you’re a failure or have let yourself or your family down	0	1	2	3
7. Trouble concentrating on things, such as reading the newspaper or watching television	0	1	2	3
8. Moving or speaking so slowly that other people could have noticed. Or, the opposite—being so fidgety or restless that you have been moving around a lot more than usual	0	1	2	3
9. Thoughts that you would be better off dead or of hurting yourself in some way	0	1	2	3
10. If you checked off any problems, how difficult have those problems made it for you to do your work, take care of things at home, or get along with other people?	Not difficult at all	Somewhat difficult	Very difficult	Extremely difficult

Table 2

Patient demographics.

Demographics	Total (n = 66)
Age, y, mean ± SD	47.2 ± 10.1
Gender
Female	42.4% (28)
Male	57.6% (38)
Body mass index
<30 kg/m²	53.0% (35)
≥30 kg/m²	47.0% (31)
Smoking status
Nonsmoker	84.9% (56)
Smoker	15.2% (10)
Diabetes
Nondiabetic	86.4% (57)
Diabetic	13.6% (9)
American Society of Anesthesiologists classification	1.9 ± 0.6
Charlson Comorbidity Index score	1.4 ± 2.0
Ethnicity
White	71.2% (47)
African American	12.1% (8)
Hispanic	10.6% (7)
Asian	3.0% (2)
Insurance
Medicare/Medicaid	1.5% (1)
Workers’ compensation	27.3% (18)
Private	71.2% (47)

Table 3

Perioperative characteristics.

Characteristics	Total (n = 66)
Spinal pathology
Central stenosis	42.4% (28)
Herniated nucleus pulposus	95.5% (63)
Myeloradiculopathy	87.9% (58)
Operative time,^{^a} min, mean ± SD	50.3 ± 10.6
Estimated blood loss, mL, mean ± SD	27.5 ± 10.1
Length of stay, h, mean ± SD	10.1 ± 7.6
Day of discharge
POD0	81.8% (54)
POD1	18.2% (12)

Table 4

Postoperative outcomes.

Outcomes	Mean ± SD
VAS neck
Preoperative	6.1 ± 2.4
6 wk	3.3 ± 2.7
12 wk	2.8 ± 2.4
6 mo	2.5 ± 2.3
1 y	3.1 ± 2.7
2 y	5.0 ± 2.7
MCID achievement, % (n)	75.8% (47)
VAS arm
Preoperative	6.0 ± 2.8
6 wk	2.4 ± 2.6
12 wk	3.0 ± 3.2
6 mo	2.8 ± 3.0
1 y	4.0 ± 3.4
2 y	3.9 ± 2.9
MCID achievement, % (n)	58.1% (36)
Neck Disability Index
Preoperative	37.2 ± 16.0
6 wk	30.1 ± 19.1
12 wk	26.4 ± 19.3
6 mo	21.0 ± 18.9
1 y	20.2 ± 19.0
2 y	24.1 ± 18.2
MCID achievement, % (n)	70.5% (43)
12-Item Short Form physical component score
Preoperative	36.1 ± 8.1
6 wk	35.3 ± 8.1
12 wk	38.5 ± 10.4
6 mo	42.1 ± 8.7
1 y	43.3 ± 11.3
2 y	43.5 ± 10.9
MCID achievement, % (n)	47.4% (27)
Patient-Reported Outcomes Measurement Information System Physical Function
Preoperative	39.6 ± 7.2
6 wk	40.7 ± 6.7
12 wk	44.8 ± 9.4
6 mo	45.5 ± 7.8
1 y	47.9 ± 7.7
2 y	45.5 ± 8.8
MCID achievement, % (n)	66.0% (31)

Abbreviations: MCID, minimum clinically important difference; VAS, visual analog scale.
Note: Data presented as mean ± SD unless otherwise indicated.

Table 5

PHQ-9 items as predictors of pain and disability MCID achievement.

Abbreviations: MCID, minimum clinically important difference; PHQ, Patient Health Questionnaire; VAS, visual analog scale.
Note: Boldface indicates statistical significance.
↵a P values calculated using logistic regression to assess each question as a predictor of MCID achievement.
↵b Unable to assess question 9 due to the limited number of patients with affirmative responses.

Table 6

PHQ-9 items as predictors of physical function MCID achievement.

PHQ-9 Items	OR	95% CI	P Value^{^a} ^{^b}
12-Item Short Form physical component score MCID
Question 1	1.6	(0.9, 2.7)	0.092
Question 2	1.2	(0.7, 2.0)	0.624
Question 3	1.7	(1.0, 2.9)	0.037
Question 4	1.5	(0.8, 2.6)	0.167
Question 5	1.4	(0.7, 2.5)	0.355
Question 6	1.2	(0.6, 2.3)	0.632
Question 7	1.2	(0.7, 2.2)	0.460
Question 8	1.6	(0.7, 3.5)	0.253
Question 9^b	-	-	-
Question 10	1.4	(0.7, 2.7)	0.309
Overall PHQ-9 score	1.1	(0.9, 1.2)	0.205
Patient-Reported Outcomes Measurement Information System Physical Function MCID
Question 1	1.6	(0.9, 2.9)	0.137
Question 2	1.1	(0.6, 2.1)	0.724
Question 3	1.1	(0.6, 1.9)	0.828
Question 4	1.3	(0.7, 2.4)	0.456
Question 5	0.8	(0.4, 1.5)	0.503
Question 6	0.9	(0.5, 1.9)	0.870
Question 7	1.3	(0.7, 2.6)	0.388
Question 8	1.3	(0.5, 3.0)	0.576
Question 9^b	-	-	-
Question 10	1.3	(0.6, 2.7)	0.473
Overall PHQ-9 score	1.1	(0.9, 1.2)	0.263

Abbreviations: MCID, minimum clinically important difference; PHQ, Patient Health Questionnaire.
Note: Boldface indicates statistical significance.
↵a P values calculated using logistic regression to assess each question as a predictor of MCID achievement.
↵b Unable to assess question 9 due to the limited number of patients with affirmative responses.