Clinical predictors of surgical selection for individuals with neck pain.

Abstract

Background: 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.

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

Design: Retrospective analysis on prospectively collected data.

Methods: 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.

Results: 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).

Conclusion: 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.