Rohan I. Suresh

Background/Objectives: Patient-reported outcome measures (PROMs) are widely used tools in orthopedic surgery for evaluating clinical outcomes, guiding research, and supporting value-based care. However, the optimal timing for collecting baseline PROMs, whether in clinic prior to surgery or on the day of surgery, remains uncertain. This study investigated whether the clinical setting (preoperative clinic vs. day of surgery) affects baseline PROMs in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: Patients undergoing elective, primary ACDF at a single institution between August 2019 and June 2021 were prospectively enrolled. Inclusion criteria included age over 18, English literacy, and eligibility for primary ACDF. Participants completed PROMIS domains, Neck Disability Index (NDI), Modified Japanese Orthopaedic Association (mJOA) score, and Visual Analog Scale (VAS) at two time points: during the preoperative clinic visit and again in the perioperative area on the day of surgery. A subgroup analysis was performed for patients with anxiety, defined as a PROMIS anxiety score ≥ 59.4. Results: A total of 63 patients were enrolled, with 48 completing both sets of surveys. The average time between the two assessments was 7.9 days (95% CI: 6.4–9.3). After Bonferroni correction (α = 0.005), no significant differences were observed in any PROMs across the two time points, including PROMIS physical function (p = 0.398), pain interference (p = 0.682), fatigue (p = 0.019), social satisfaction (p = 0.331), anxiety (p = 0.047), depression (p = 0.042), NDI (p = 0.072), mJOA (p = 0.566), VAS neck pain (p = 0.054), or VAS overall pain (p = 0.335). Subgroup analysis of anxious patients similarly revealed no statistically significant changes between settings. Conclusions: PROM scores were not meaningfully different between the preoperative clinic and the day of surgery in patients undergoing ACDF. These results are most applicable when baseline PROMs are collected within about one week of ACDF. These findings support flexibility in workflow design for PROM collection, as the timing and setting do not significantly impact baseline responses.

Background/Objectives: Cutibacterium acnes (C. acnes), formerly known as Propionibacterium acnes (P. acnes), is an anaerobic, low-virulent bacterium that has been associated with postoperative infections of the shoulder, knee, and cervical spine. Recent studies have highlighted an association between C. acnes and the development of degenerative disc disease (DDD). The aim of this study is to ascertain whether C. acnes increases the risk of subsidence following anterior cervical discectomy and fusion (ACDF). Methods: After IRB approval, consecutive patients undergoing elective ACDF for DDD from 2017 to 2018 were enrolled in this prospective cohort study. Intervertebral disc samples were taken at each affected level and cultured. A total of 66 patients with radiographic follow-ups were included in the final analysis. The extent of subsidence and cervical lordosis was determined immediately postoperatively and at the 3- and 6-month follow-ups. Results: No significant difference in subsidence was observed at 3 months (p = 0.07) or 6 months (p = 0.11) between culture-positive and -negative cohorts. Additionally, there was no significant difference detected in the change in cervical lordosis observed at 3 months (p = 0.16) or 6 months (p = 0.27) between culture-positive and -negative cohorts. For the most inferiorly fused segment, there was a significant difference in subsidence observed at 3 months (1.5 mm, 95% CI: 0.2–2.7 mm, p = 0.02) but not at 6 months (p = 0.17). Conclusions: Intervertebral discs with a positive C. acnes culture were not associated with greater levels of subsidence at 3 or 6 months following ACDF for DDD. Further research is necessary to endorse these results and to gauge the clinical significance of C. acnes infection.