Objectives:

Patients with a history of surgically treated cervical myelopathy and lumbar pathology requiring fusion present complex challenges. There is a paucity of literature describing patient reported outcomes in this cohort beyond tandem spinal stenosis patients. This has led to unclear guidelines in the literature. We present the first dataset comparing patient reported outcomes for lumbar fusion in patients with isolated lumbar pathology versus those with a history of surgically treated cervical myelopathy.

Methods:

A retrospective cohort study of a prospectively collected lumbar fusion database was completed. Variables of interest included demographics, comorbidities, type and levels of fusion, Oswestry Disability Index (ODI), and minimal clinical important difference (MCID).

Results:

325 patients were identified; 309 met inclusion criteria. 29 had previous cervical surgery to address cervical myelopathy. Median time between cervical and lumbar surgery was 4.0 years [0.3 to 19.7]. There was no statistical difference in the pre-operative ODI (24.8 vs. 25.6 p = 0.687), 6-month post-operative ODI (17.3 vs. 18.7, p = 0.459), change in ODI (7.5 vs. 6.9, p = 0.673), or MCID in ODI (62.1% vs. 58.6%, p = 0.710) in those who had undergone cervical surgery vs those who had not.

Conclusion:

Patients with previously treated cervical myelopathy have a similar rate of clinically relevant improvement after lumbar fusion as compared to those who did not. As such, these patients appear to benefit from lumbar fusion surgery to the same degree as patients without a history of surgically treated cervical myelopathy.