Comprehensive Assessment of One-Year Outcomes and Determination of Minimum Clinically Important Difference in Pain, Disability, and Quality of Life After Suboccipital Decompression for Chiari I Malformation in Adults.
Neurosurgery. 2013 Jun 19;
Authors: Parker SL, Godil SS, Zuckerman SL, Mendenhall SK, Wells JA, Shau DN, McGirt MJ
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 (PRO) measures.
OBJECTIVE:: We set out to determine the effectiveness and minimum clinically important difference (MCID) thresholds of SOC for treatment of adult patients with CMI utilizing PRO metrics.
METHODS:: Fifty patients undergoing first-time SOC and C1 laminectomy for CMI at a single institution were followed for 1 year. Baseline and 1-year post-operative pain, disability, quality of life, patient satisfaction, and return to work were assessed. MCID thresholds were calculated using 2 anchors: health transition index (HTI) and NASS satisfaction.
RESULTS:: The severity of headaches improved in 37 (74%) patients. Improvement in syrinx size was seen in 12 (63%) and myelopathy was seen in 12 (60%) patients. All PROs showed significant improvement 1-year post-operatively (p value <0.05). Of the 38 (76%) patients employed preoperatively, 29 (76%) returned to work post-operatively at a median time of 6 weeks [IQR: 4-12 weeks]. MCID thresholds following SOC for CMI were 4.4 points for NRS-Head, 0.7 points for NRS-Neck, 13.8 percentage points for HDI, 14.2 percentage points for NDI, 7.0 points for SF-12 PCS, 6.1 points for SF-12 MCS, 4.5 points for Zung depression, 1.7 points for mJOA, and 0.34 QALYs for EQ-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.
PMID: 23787878 [PubMed – as supplied by publisher]