Comprehensive Assessment of 1-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari Malformation I in Adults
Abstract BACKGROUND: To date, there has been no study to comprehensively assess the effectiveness of suboccipital craniectomy (SOC) for Chiari malformation I (CMI) using validated patient-reported outcome measures. OBJECTIVE: To determine the effectiveness and minimum clinically important difference...
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| Veröffentlicht in: | Neurosurgery 2013-10, Vol.73 (4), p.569-581 |
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| creator | Parker, Scott L. Godil, Saniya S. Zuckerman, Scott L. Mendenhall, Stephen K. Wells, John A. Shau, David N. McGirt, Matthew J. |
| description | Abstract
BACKGROUND:
To date, there has been no study to comprehensively assess the effectiveness of suboccipital craniectomy (SOC) for Chiari malformation I (CMI) using validated patient-reported outcome measures.
OBJECTIVE:
To determine the effectiveness and minimum clinically important difference thresholds of SOC for the treatment of adult patients with CMI using patient-reported outcome metrics.
METHODS:
Fifty patients undergoing first-time SOC and C1 laminectomy for CMI at a single institution were followed up for 1 year. Baseline and 1-year postoperative pain, disability, quality of life, patient satisfaction, and return to work were assessed. Minimum clinically important difference thresholds were calculated with 2 anchors: the Health Transition Index and North American Spine Society satisfaction questionnaire.
RESULTS:
The severity of headaches improved in 37 patients (74%). Improvement in syrinx size was seen in 12 patients (63%) and myelopathy in 12 patients (60%). All patient-reported outcomes showed significant improvement 1 year postoperatively (P |
| doi_str_mv | 10.1227/NEU.0000000000000032 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1434742713</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1227/NEU.0000000000000032</oup_id><sourcerecordid>2357368403</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4242-fcef76661d557eb6000837bfe88ea7a68a3d7bab3fd8d82cbd2e3f3dce64ef5b3</originalsourceid><addsrcrecordid>eNqNUU1v1DAUjBCIbgv_ACFLXDg0bWJ7Y3NcpaWstKUgqASnyHGetS7-CHZMtX-U34PTLUj0AvbB71nzZkZviuJFXZ3UGLPT9-fXJ9Vfh-BHxaJeYlrSilaPi0VVU16SN82Xg-IwxpuqqhvK-NPiABPG57sofrbejgG24KL-AWgVI8RowU3IK1SXX0EEdJUm6S1EJNyAzmCCYLUTk_ZuBl1qp22yqDW5kMKYHVrb0YdJZJIzrRQEcBKQduiD0O44_0XRa6On3fEd48ck5mbm2miVPaisgD6l3kupRz0Jk0Xlnc0YZ1HlA2q3WgSNLoXJnd2bWc8aqyGZKT4rnihhIjy_f4-K67fnn9t35ebqYt2uNqWkmOJSSVCsaZp6WC4Z9E1eIiesV8A5CCYaLsjAetETNfCBY9kPGIgig4SGglr25Kh4vecdg_-eIE6d1VGCMcKBT7GrKaGMYlaTDH31AHrjU3DZXYfJkpGG02pG0T1KBh9jANWNQVsRdl1ddXPuXc69e5h7Hnt5T556C8Ofod9BZwDfA269yeuN30y6hdBtQZhp-y_u0_2oT-P_ufkFDQvLZQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2357368403</pqid></control><display><type>article</type><title>Comprehensive Assessment of 1-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari Malformation I in Adults</title><source>MEDLINE</source><source>Journals@Ovid Complete</source><creator>Parker, Scott L. ; Godil, Saniya S. ; Zuckerman, Scott L. ; Mendenhall, Stephen K. ; Wells, John A. ; Shau, David N. ; McGirt, Matthew J.</creator><creatorcontrib>Parker, Scott L. ; Godil, Saniya S. ; Zuckerman, Scott L. ; Mendenhall, Stephen K. ; Wells, John A. ; Shau, David N. ; McGirt, Matthew J.</creatorcontrib><description>Abstract
BACKGROUND:
To date, there has been no study to comprehensively assess the effectiveness of suboccipital craniectomy (SOC) for Chiari malformation I (CMI) using validated patient-reported outcome measures.
OBJECTIVE:
To determine the effectiveness and minimum clinically important difference thresholds of SOC for the treatment of adult patients with CMI using patient-reported outcome metrics.
METHODS:
Fifty patients undergoing first-time SOC and C1 laminectomy for CMI at a single institution were followed up for 1 year. Baseline and 1-year postoperative pain, disability, quality of life, patient satisfaction, and return to work were assessed. Minimum clinically important difference thresholds were calculated with 2 anchors: the Health Transition Index and North American Spine Society satisfaction questionnaire.
RESULTS:
The severity of headaches improved in 37 patients (74%). Improvement in syrinx size was seen in 12 patients (63%) and myelopathy in 12 patients (60%). All patient-reported outcomes showed significant improvement 1 year postoperatively (P < .05). Of the 38 patients (76%) employed preoperatively, 29 (76%) returned to work postoperatively at a median time of 6 weeks (interquartile range, 4-12 weeks). Minimum clinically important difference thresholds after SOC for CMI were 4.4 points for numeric rating scale for headache, 0.7 points for numeric rating scale for neck pain, 13.8 percentage points for Headache Disability Index, 14.2 percentage points for Neck Disability Index, 7.0 points for Short Form-12 Physical Component Summary, 6.1 points for Short Form-12 Mental Component Summary, 4.5 points for Zung depression, 1.7 points for modified Japanese Orthopaedic Association, and 0.34 quality-adjusted life-years for Euro-Qol-5D.
CONCLUSION:
Surgical management of CMI in adults via SOC provides significant and sustained improvement in pain, disability, general health, and quality of life as assessed by patient-reported outcomes. This patient-centered assessment suggests that suboccipital decompression for CMI in adults is an effective treatment strategy.</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/NEU.0000000000000032</identifier><identifier>PMID: 23787878</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adolescent ; Adult ; Aged ; Arnold-Chiari Malformation - complications ; Arnold-Chiari Malformation - surgery ; Decompressive Craniectomy - methods ; Disability Evaluation ; Female ; Humans ; Male ; Middle Aged ; Neurosurgery ; Pain ; Pain - etiology ; Pain - surgery ; Patient Satisfaction ; Quality of Life ; Treatment Outcome ; Young Adult</subject><ispartof>Neurosurgery, 2013-10, Vol.73 (4), p.569-581</ispartof><rights>Copyright © 2013 by the Congress of Neurological Surgeons 2013</rights><rights>Copyright © by the Congress of Neurological Surgeons</rights><rights>Copyright © 2013 by the Congress of Neurological Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4242-fcef76661d557eb6000837bfe88ea7a68a3d7bab3fd8d82cbd2e3f3dce64ef5b3</citedby><cites>FETCH-LOGICAL-c4242-fcef76661d557eb6000837bfe88ea7a68a3d7bab3fd8d82cbd2e3f3dce64ef5b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23787878$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Parker, Scott L.</creatorcontrib><creatorcontrib>Godil, Saniya S.</creatorcontrib><creatorcontrib>Zuckerman, Scott L.</creatorcontrib><creatorcontrib>Mendenhall, Stephen K.</creatorcontrib><creatorcontrib>Wells, John A.</creatorcontrib><creatorcontrib>Shau, David N.</creatorcontrib><creatorcontrib>McGirt, Matthew J.</creatorcontrib><title>Comprehensive Assessment of 1-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari Malformation I in Adults</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>Abstract
BACKGROUND:
To date, there has been no study to comprehensively assess the effectiveness of suboccipital craniectomy (SOC) for Chiari malformation I (CMI) using validated patient-reported outcome measures.
OBJECTIVE:
To determine the effectiveness and minimum clinically important difference thresholds of SOC for the treatment of adult patients with CMI using patient-reported outcome metrics.
METHODS:
Fifty patients undergoing first-time SOC and C1 laminectomy for CMI at a single institution were followed up for 1 year. Baseline and 1-year postoperative pain, disability, quality of life, patient satisfaction, and return to work were assessed. Minimum clinically important difference thresholds were calculated with 2 anchors: the Health Transition Index and North American Spine Society satisfaction questionnaire.
RESULTS:
The severity of headaches improved in 37 patients (74%). Improvement in syrinx size was seen in 12 patients (63%) and myelopathy in 12 patients (60%). All patient-reported outcomes showed significant improvement 1 year postoperatively (P < .05). Of the 38 patients (76%) employed preoperatively, 29 (76%) returned to work postoperatively at a median time of 6 weeks (interquartile range, 4-12 weeks). Minimum clinically important difference thresholds after SOC for CMI were 4.4 points for numeric rating scale for headache, 0.7 points for numeric rating scale for neck pain, 13.8 percentage points for Headache Disability Index, 14.2 percentage points for Neck Disability Index, 7.0 points for Short Form-12 Physical Component Summary, 6.1 points for Short Form-12 Mental Component Summary, 4.5 points for Zung depression, 1.7 points for modified Japanese Orthopaedic Association, and 0.34 quality-adjusted life-years for Euro-Qol-5D.
CONCLUSION:
Surgical management of CMI in adults via SOC provides significant and sustained improvement in pain, disability, general health, and quality of life as assessed by patient-reported outcomes. This patient-centered assessment suggests that suboccipital decompression for CMI in adults is an effective treatment strategy.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Arnold-Chiari Malformation - complications</subject><subject>Arnold-Chiari Malformation - surgery</subject><subject>Decompressive Craniectomy - methods</subject><subject>Disability Evaluation</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neurosurgery</subject><subject>Pain</subject><subject>Pain - etiology</subject><subject>Pain - surgery</subject><subject>Patient Satisfaction</subject><subject>Quality of Life</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNUU1v1DAUjBCIbgv_ACFLXDg0bWJ7Y3NcpaWstKUgqASnyHGetS7-CHZMtX-U34PTLUj0AvbB71nzZkZviuJFXZ3UGLPT9-fXJ9Vfh-BHxaJeYlrSilaPi0VVU16SN82Xg-IwxpuqqhvK-NPiABPG57sofrbejgG24KL-AWgVI8RowU3IK1SXX0EEdJUm6S1EJNyAzmCCYLUTk_ZuBl1qp22yqDW5kMKYHVrb0YdJZJIzrRQEcBKQduiD0O44_0XRa6On3fEd48ck5mbm2miVPaisgD6l3kupRz0Jk0Xlnc0YZ1HlA2q3WgSNLoXJnd2bWc8aqyGZKT4rnihhIjy_f4-K67fnn9t35ebqYt2uNqWkmOJSSVCsaZp6WC4Z9E1eIiesV8A5CCYaLsjAetETNfCBY9kPGIgig4SGglr25Kh4vecdg_-eIE6d1VGCMcKBT7GrKaGMYlaTDH31AHrjU3DZXYfJkpGG02pG0T1KBh9jANWNQVsRdl1ddXPuXc69e5h7Hnt5T556C8Ofod9BZwDfA269yeuN30y6hdBtQZhp-y_u0_2oT-P_ufkFDQvLZQ</recordid><startdate>20131001</startdate><enddate>20131001</enddate><creator>Parker, Scott L.</creator><creator>Godil, Saniya S.</creator><creator>Zuckerman, Scott L.</creator><creator>Mendenhall, Stephen K.</creator><creator>Wells, John A.</creator><creator>Shau, David N.</creator><creator>McGirt, Matthew J.</creator><general>Oxford University Press</general><general>Copyright by the Congress of Neurological Surgeons</general><general>Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20131001</creationdate><title>Comprehensive Assessment of 1-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari Malformation I in Adults</title><author>Parker, Scott L. ; Godil, Saniya S. ; Zuckerman, Scott L. ; Mendenhall, Stephen K. ; Wells, John A. ; Shau, David N. ; McGirt, Matthew J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4242-fcef76661d557eb6000837bfe88ea7a68a3d7bab3fd8d82cbd2e3f3dce64ef5b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Arnold-Chiari Malformation - complications</topic><topic>Arnold-Chiari Malformation - surgery</topic><topic>Decompressive Craniectomy - methods</topic><topic>Disability Evaluation</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neurosurgery</topic><topic>Pain</topic><topic>Pain - etiology</topic><topic>Pain - surgery</topic><topic>Patient Satisfaction</topic><topic>Quality of Life</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Parker, Scott L.</creatorcontrib><creatorcontrib>Godil, Saniya S.</creatorcontrib><creatorcontrib>Zuckerman, Scott L.</creatorcontrib><creatorcontrib>Mendenhall, Stephen K.</creatorcontrib><creatorcontrib>Wells, John A.</creatorcontrib><creatorcontrib>Shau, David N.</creatorcontrib><creatorcontrib>McGirt, Matthew J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Parker, Scott L.</au><au>Godil, Saniya S.</au><au>Zuckerman, Scott L.</au><au>Mendenhall, Stephen K.</au><au>Wells, John A.</au><au>Shau, David N.</au><au>McGirt, Matthew J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comprehensive Assessment of 1-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari Malformation I in Adults</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2013-10-01</date><risdate>2013</risdate><volume>73</volume><issue>4</issue><spage>569</spage><epage>581</epage><pages>569-581</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><abstract>Abstract
BACKGROUND:
To date, there has been no study to comprehensively assess the effectiveness of suboccipital craniectomy (SOC) for Chiari malformation I (CMI) using validated patient-reported outcome measures.
OBJECTIVE:
To determine the effectiveness and minimum clinically important difference thresholds of SOC for the treatment of adult patients with CMI using patient-reported outcome metrics.
METHODS:
Fifty patients undergoing first-time SOC and C1 laminectomy for CMI at a single institution were followed up for 1 year. Baseline and 1-year postoperative pain, disability, quality of life, patient satisfaction, and return to work were assessed. Minimum clinically important difference thresholds were calculated with 2 anchors: the Health Transition Index and North American Spine Society satisfaction questionnaire.
RESULTS:
The severity of headaches improved in 37 patients (74%). Improvement in syrinx size was seen in 12 patients (63%) and myelopathy in 12 patients (60%). All patient-reported outcomes showed significant improvement 1 year postoperatively (P < .05). Of the 38 patients (76%) employed preoperatively, 29 (76%) returned to work postoperatively at a median time of 6 weeks (interquartile range, 4-12 weeks). Minimum clinically important difference thresholds after SOC for CMI were 4.4 points for numeric rating scale for headache, 0.7 points for numeric rating scale for neck pain, 13.8 percentage points for Headache Disability Index, 14.2 percentage points for Neck Disability Index, 7.0 points for Short Form-12 Physical Component Summary, 6.1 points for Short Form-12 Mental Component Summary, 4.5 points for Zung depression, 1.7 points for modified Japanese Orthopaedic Association, and 0.34 quality-adjusted life-years for Euro-Qol-5D.
CONCLUSION:
Surgical management of CMI in adults via SOC provides significant and sustained improvement in pain, disability, general health, and quality of life as assessed by patient-reported outcomes. This patient-centered assessment suggests that suboccipital decompression for CMI in adults is an effective treatment strategy.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>23787878</pmid><doi>10.1227/NEU.0000000000000032</doi><tpages>13</tpages></addata></record> |
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| ispartof | Neurosurgery, 2013-10, Vol.73 (4), p.569-581 |
| issn | 0148-396X 1524-4040 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adolescent Adult Aged Arnold-Chiari Malformation - complications Arnold-Chiari Malformation - surgery Decompressive Craniectomy - methods Disability Evaluation Female Humans Male Middle Aged Neurosurgery Pain Pain - etiology Pain - surgery Patient Satisfaction Quality of Life Treatment Outcome Young Adult |
| title | Comprehensive Assessment of 1-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari Malformation I in Adults |
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