Browsing by Author "El Sammak, Sally"

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    ItemOpen Access
    Sleep Disturbances in Cervical Spondylotic Myelopathy: Prevalence and Postoperative Outcomes-an Analysis From the Quality Outcomes Database.
    (Clinical spine surgery, 2023-04) Bisson, Erica F; Mummaneni, Praveen V; Michalopoulos, Giorgos D; El Sammak, Sally; Chan, Andrew K; Agarwal, Nitin; Wang, Michael Y; Knightly, John J; Sherrod, Brandon A; Gottfried, Oren N; Than, Khoi D; Shaffrey, Christopher I; Goldberg, Jacob L; Virk, Michael S; Hussain, Ibrahim; Shabani, Saman; Glassman, Steven D; Tumialan, Louis M; Turner, Jay D; Uribe, Juan S; Meyer, Scott A; Lu, Daniel C; Buchholz, Avery L; Upadhyaya, Cheerag; Shaffrey, Mark E; Park, Paul; Foley, Kevin T; Coric, Domagoj; Slotkin, Jonathan R; Potts, Eric A; Stroink, Ann R; Chou, Dean; Fu, Kai-Ming G; Haid, Regis W; Asher, Anthony L; Bydon, Mohamad

    Study design

    Prospective observational study, level of evidence 1 for prognostic investigations.

    Objectives

    To evaluate the prevalence of sleep impairment and predictors of improved sleep quality 24 months postoperatively in cervical spondylotic myelopathy (CSM) using the quality outcomes database.

    Summary of background data

    Sleep disturbances are a common yet understudied symptom in CSM.

    Materials and methods

    The quality outcomes database was queried for patients with CSM, and sleep quality was assessed through the neck disability index sleep component at baseline and 24 months postoperatively. Multivariable logistic regressions were performed to identify risk factors of failure to improve sleep impairment and symptoms causing lingering sleep dysfunction 24 months after surgery.

    Results

    Among 1135 patients with CSM, 904 (79.5%) had some degree of sleep dysfunction at baseline. At 24 months postoperatively, 72.8% of the patients with baseline sleep symptoms experienced improvement, with 42.5% reporting complete resolution. Patients who did not improve were more like to be smokers [adjusted odds ratio (aOR): 1.85], have osteoarthritis (aOR: 1.72), report baseline radicular paresthesia (aOR: 1.51), and have neck pain of ≥4/10 on a numeric rating scale. Patients with improved sleep noted higher satisfaction with surgery (88.8% vs 72.9%, aOR: 1.66) independent of improvement in other functional areas. In a multivariable analysis including pain scores and several myelopathy-related symptoms, lingering sleep dysfunction at 24 months was associated with neck pain (aOR: 1.47) and upper (aOR: 1.45) and lower (aOR: 1.52) extremity paresthesias.

    Conclusion

    The majority of patients presenting with CSM have associated sleep disturbances. Most patients experience sustained improvement after surgery, with almost half reporting complete resolution. Smoking, osteoarthritis, radicular paresthesia, and neck pain ≥4/10 numeric rating scale score are baseline risk factors of failure to improve sleep dysfunction. Improvement in sleep symptoms is a major driver of patient-reported satisfaction. Incomplete resolution of sleep impairment is likely due to neck pain and extremity paresthesia.
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    ItemOpen Access
    What factors influence surgical decision-making in anterior versus posterior surgery for cervical myelopathy? A QOD analysis.
    (Journal of neurosurgery. Spine, 2023-11) Park, Christine; Shaffrey, Christopher I; Than, Khoi D; Michalopoulos, Giorgos D; El Sammak, Sally; Chan, Andrew K; Bisson, Erica F; Sherrod, Brandon A; Asher, Anthony L; Coric, Domagoj; Potts, Eric A; Foley, Kevin T; Wang, Michael Y; Fu, Kai-Ming; Virk, Michael S; Knightly, John J; Meyer, Scott; Park, Paul; Upadhyaya, Cheerag; Shaffrey, Mark E; Buchholz, Avery L; Tumialán, Luis M; Turner, Jay; Agarwal, Nitin; Chou, Dean; Chaudhry, Nauman S; Haid, Regis W; Mummaneni, Praveen V; Bydon, Mohamad; Gottfried, Oren N

    Objective

    The aim of this study was to explore the preoperative patient characteristics that affect surgical decision-making when selecting an anterior or posterior operative approach in patients diagnosed with cervical spondylotic myelopathy (CSM).

    Methods

    This was a multi-institutional, retrospective study of the prospective Quality Outcomes Database (QOD) Cervical Spondylotic Myelopathy module. Patients aged 18 years or older diagnosed with primary CSM who underwent multilevel (≥ 2-level) elective surgery were included. Demographics and baseline clinical characteristics were collected.

    Results

    Of the 841 patients with CSM in the database, 492 (58.5%) underwent multilevel anterior surgery and 349 (41.5%) underwent multilevel posterior surgery. Surgeons more often performed a posterior surgical approach in older patients (mean 64.8 ± 10.6 vs 58.5 ± 11.1 years, p < 0.001) and those with a higher American Society of Anesthesiologists class (class III or IV: 52.4% vs 46.3%, p = 0.003), a higher rate of motor deficit (67.0% vs 58.7%, p = 0.014), worse myelopathy (mean modified Japanese Orthopaedic Association score 11.4 ± 3.1 vs 12.4 ± 2.6, p < 0.001), and more levels treated (4.3 ± 1.3 vs 2.4 ± 0.6, p < 0.001). On the other hand, surgeons more frequently performed an anterior surgical approach when patients were employed (47.2% vs 23.2%, p < 0.001) and had intervertebral disc herniation as an underlying pathology (30.7% vs 9.2%, p < 0.001).

    Conclusions

    The selection of approach for patients with CSM depends on patient demographics and symptomology. Posterior surgery was performed in patients who were older and had worse systemic disease, increased myelopathy, and greater levels of stenosis. Anterior surgery was more often performed in patients who were employed and had intervertebral disc herniation.