Author(s): Janous P.; Buxton N.; Pigott T.; Teli M.; Clark S.
Source: European Spine Journal; 2017; vol. 26 (no. 2)
Publication Date: 2017
Publication Type(s): Conference Abstract
Available at European Spine Journal – from SpringerLink – Medicine
Abstract:Objective: To evaluate the impact of concomitant syringomyelia on patient reported outcome measures and complications in patients undergoing hindbrain decompression for a Chiari 1 malformation. Design: Prospective data collection within the Spine Tango Registry data for one institution. Subjects: 95 patients undergoing Foramen Magnum Decompression (FMD) between March 2011 and March 2015. Methods: Outcome evaluation was performed using the neck Core Outcome Measures Index (COMI neck) and Gestalt impression (to assess improvement of headaches) was applied retrospectively at 12 months. Patients were split into two cohorts, those with and those without syringomyelia. Both cohorts were compared in all domains of the COMI neck questionnaires, headaches (Gestalt impression) and complications. Non-parametric data were analysed with Wilcoxon signed rank test (baseline and 12 months data), Man-Whitney U test and Fisher exact test (comparison of 12 months outcomes). Parametric data (age) were analysed with Student T-test. SPSS Software was used for above analysis. Results: 79 out of 95 (83%) patients returned 1 year follow-up COMI neck questionnaires. Thirty-three had concomitant syringomyelia and 46 had no syringomyelia present. There was no statistical difference in age, gender or ASA grade (p>0.05) between cohorts. Significantly more patients (11 vs. 4; p = 0.0186) had repeat surgery in syrinx group. There was no statistically significant difference in patient reported outcomes (COMI neck index median 4.5 +/- 3.3 vs 4.2 +/- 3.2; p = 0.376) between the syrinx and non-syrinx cohorts. However postoperative neck pain (median 4 +/- 3.35 vs 1 +/- 3.17; p 0.041) and arm/shoulder pain scores (2 +/- 3.38 vs. 0 +/- 2.628; 0.049) were significantly lower in the non-syrinx cohort. In both cohorts 57% patients had an improvement in headaches. 92% patients were ‘satisfied’ with treatment and 63% stated that the operation ‘helped’. 54% and 59% of patients in the syrinx and non-syrinx cohorts, respectively self-reported complications as a consequence of the operation. Statistical difference was not reached when comparing COMI neck index of patients with self-reported complications and without (p = 0.121). Overall, 25% patients required insertion of ventriculo-peritoneal shunt. Conclusions: This study demonstrates that clinical effectiveness of FMD is lower and self-reported complications are higher when evaluated by patients via patient reported outcome measures. Patients with and without concomitant syrinx showed equal overall outcomes, although neck and arm pain was higher in syrinx patients. High patients satisfaction with treatment reflects high standards of provided care in our institution. Self-reported complications did not have effect on outcomes.