The Effect of Patient Resilience on Postoperative Scores After One and Two-level Anterior Cervical Discectomy and Fusion.

ABSTRACT

OBJECTIVE: The purpose is to investigate the association between resilience and outcomes of pain and neck-related disability after single- and two-level anterior cervical discectomy and fusion (ACDF). METHODS: Patients who underwent single- or two-level ACDF were sent a survey between six months and two years following surgery. The survey included the Brief Resilience Scale (BRS), Visual Analogue Scale (VAS) for pain, Neck Disability Index (NDI), and Pain Self-Efficacy Questionnaire (PSEQ-2). Patients completed the VAS and NDI twice, once describing preoperative pain and disability and once describing current pain and disability. Respondents were classified as high resilience (HR), medium resilience (MR), or low resilience (LR). Demographics, PSEQ-2 scores, pre- and postoperative VAS and NDI scores, and change in VAS (ΔVAS) and NDI (ΔNDI) scores were compared between groups. RESULTS: Thirty-three patients comprised the HR group, 273 patients comprised the MR group, and 47 patients comprised the LR group. All groups demonstrated postoperative improvement in VAS and NDI scores that exceeded previously established MCID values. The HR group demonstrated greater improvement in pain compared to the LR group (ΔVAS -5.8 for HR vs -4.4 for LR, p=0.05). Compared to the MR group, the LR group demonstrated greater postoperative pain (VAS 3.2 for LR vs 2.5 for MR, p=0.02) and disability (NDI 11.9 for LR vs 8.6 for MR, p=0.02). CONCLUSIONS: Patients demonstrated improvement in pain and neck-related disability after single- and two-level ACDF, regardless of resilience score. Patients with greater resilience may be expected to demonstrate more improvement in pain after ACDF.