Cervical spondylotic myelopathy and driving abilities: defining the prevalence and long-term postoperative outcomes using the Quality Outcomes Database
Authors: Agarwal Nitin , Johnson Sarah E. , Bydon Mohamad , Bisson Erica F. , Chan Andrew K. , Shabani Saman , Letchuman Vijay , Michalopoulos Giorgos D. , Lu Daniel C. , Wang Michael Y. , Lavadi Raj Swaroop , Haid Regis W. , Knightly John J. , Sherrod Brandon A. , Gottfried Oren N. , Shaffrey Christopher I. , Goldberg Jacob L. , Virk Michael S. , Hussain Ibrahim , Glassman Steven D. , Shaffrey Mark E. , Park Paul , Foley Kevin T. , Pennicooke Brenton , Coric Domagoj , Slotkin Jonathan R. , Upadhyaya Cheerag , Potts Eric A. , Tumialán Luis M. , Chou Dean , Fu Kai-Ming G. , Asher Anthony L. , Mummaneni Praveen V. 
Published: April 2024

OBJECTIVE

Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and a subsequent reduction in an individual’s quality of life due to neurological deterioration. The positive impact of surgery on postoperative patient-reported driving capabilities has been seldom explored.

METHODS

The CSM module of the Quality Outcomes Database was utilized. Patient-reported driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire. This is an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to symptoms. Patients were considered to have an impairment in their driving ability if they reported an NDI driving score of 3 or higher (signifying impairment in driving duration due to symptoms). Multivariable logistic regression models were fitted to evaluate mediators of baseline impairment and improvement at 24 months after surgery, which was defined as an NDI driving score < 3.

RESULTS

A total of 1128 patients who underwent surgical intervention for CSM were included, of whom 354 (31.4%) had baseline driving impairment due to CSM. Moderate (OR 2.3) and severe (OR 6.3) neck pain, severe arm pain (OR 1.6), mild-moderate (OR 2.1) and severe (OR 2.5) impairment in hand/arm dexterity, severe impairment in leg use/walking (OR 1.9), and severe impairment of urinary function (OR 1.8) were associated with impaired driving ability at baseline. Of the 291 patients with baseline impairment and available 24-month follow-up data, 209 (71.8%) reported postoperative improvement in their driving ability. This improvement seemed to be mediated particularly through the achievement of the minimal clinically important difference (MCID) in neck pain and improvement in leg function/walking. Patients with improved driving at 24 months noted higher postoperative satisfaction (88.5% vs 62.2%, p < 0.01) and were more likely to achieve a clinically significant improvement in their quality of life (50.7% vs 37.8%, p < 0.01).

CONCLUSIONS

Nearly one-third of patients with CSM report impaired driving ability at presentation. Seventy-two percent of these patients reported improvements in their driving ability within 24 months of surgery. Surgical management of CSM can significantly improve patients’ driving abilities at 24 months and hence patients’ quality of life.