Cervical Spine Research Society-Cervical Stiffness Disability Index (CSRS-CSDI): Validation of a Novel Scoring System Quantifying the Effect of Postarthrodesis Cervical Stiffness on Patient Quality of Life

Andrew S. Jack, Erik Hayman, Clifford Pierre, Wyatt L. Ramey, Christopher D. Witiw, Rod J. Oskouian, Alan H. Daniels, Andrew Pugley, Kojo Hamilton, Christopher P. Ames, Jens R. Chapman, Zoher Ghogawala, Robert A. Hart

Research output: Contribution to journalArticlepeer-review

Abstract

Study Design. Cross-sectional study. Objective. The aim was to create and validate a novel patient-reported outcome measure (PROM) focusing on stiffness-related patient functional limitations after cervical spine fusion. Summary of Background Data. Cervical arthrodesis is a common treatment for myelopathy/radiculopathy, however, results in increased neck stiffness as a collateral outcome. No current PROM exists quantifying the impact of postoperative stiffness on patient function. Methods. The Cervical Spine Research Society-Cervical Stiffness Disability Index (CSRS-CSDI) was created through a modified Delphi process. The resultant 10-item questionnaire yields a score out of 100 with higher scores indicating increased functional difficulty related to neck stiffness. Cross-sectional study of control and postoperative patients was completed for CSRS-CSDI validation. Retest reliability (intraclass correlation coefficient), internal consistency (Cronbach alpha), responsiveness (levels fused vs. CSRS-CSDI scores), and discriminatory validation (CSRS-CSDI vs. neck disability index) scores) were completed. Results. Fifty-seven surgical and 24 control patients completed the questionnaire. Surgical patients underwent a variety of procedures: 11 (19%) motion preserving operations, nine (16%) subaxial 1-2 level fusions, seven (12%) subaxial 3-5 level fusions, five (9%) C1-subaxial cervical spine fusions, 20 (35%) C2-upper thoracic spine fusions, five (9%) occiput-subaxial or thoracic spine fusions. The questionnaire demonstrated high internal consistency (Cronbach alpha=0.92) and retest reliability (intraclass correlation coefficient=0.95, P<0.001). Good responsiveness validity with a significant difference between fusion cohorts was found (P<0.001, r s=0.63). Patient CSRS-CSDI scores also correlated with neck disability index scores recorded (P<0.001, r=0.70). Conclusion. This is the first study to create a PROM addressing the functional impact of cervical stiffness following surgical arthrodesis. The CSRS-CSDI was a reliable and valid measure of postoperative stiffness impact on patient function. This may prove useful in counseling patients regarding their expected outcomes with further investigation demonstrating its value in a prospective fashion.

Original languageEnglish (US)
Pages (from-to)1263-1269
Number of pages7
JournalSpine
Volume47
Issue number18
DOIs
StatePublished - Sep 15 2022

Keywords

  • activities of living
  • arthrodesis
  • cervical
  • collateral
  • complication
  • function
  • fusion
  • outcome
  • patient-reported outcome measure
  • spine
  • spine
  • stiffness

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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