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The use of the Core Yellow Flags Index for the assessment of psychosocial distress in patients undergoing surgery of the cervical spine

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Abstract

Background

Psychosocial distress (the presence of yellow flags) has been linked to poor outcomes in spine surgery. The Core Yellow Flags Index (CYFI), a short instrument assessing the 4 main yellow flags, was developed for use in patients undergoing lumbar spine surgery. This study evaluated its ability to predict outcome in patients undergoing cervical spine surgery.

Methods

Patients with degenerative spinal disorders (excluding myelopathy) operated in one centre, from 2015 to 2019, were asked to complete the CYFI at baseline and the Core Outcome Measures Index (COMI) at baseline and 3 and 12 months after surgery. The relationship between CYFI and COMI scores at baseline as well as the predictive ability of the CYFI on the COMI follow-up scores were tested using structural equation modelling.

Results

From 731 eligible patients, 547 (61.0 ± 12.5 years; 57.2% female) completed forms at all three timepoints. On a cross-sectional basis, preoperative CYFI and COMI scores were highly correlated (β = 0.54, in men and 0.51 in women; each p < 0.001). CYFI added significantly and independently to the prediction of COMI at 3 months’ FU in men (β = 0.36) and 12 months’ FU in men and women (both β = 0.20) (all p < 0.001).

Conclusion

The CYFI had a low to moderate but significant and independent association with cervical spine surgery outcomes. Implementing the CYFI in the preoperative workup of these patients could help refine outcome predictions and better manage patient expectations.

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Acknowledgements

We thank all the patients of the Schulthess Klinik who contributed their data. We thank Dave O’Riordan, Gordana Balaban, Stéphanie Dosch, and Selina Nauer for their administration of the Spine Tango surgery forms and patient-rated outcome measures.

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Authors and Affiliations

  1. Department of Teaching, Research and Development, Spine Centre Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    Francine Mariaux & Anne F. Mannion

  2. Institute for Psychology, University of Bern, Bern, Switzerland

    Achim Elfering

  3. Spine Centre, Schulthess Klinik, Zurich, Switzerland

    Tamás F. Fekete, François Porchet, Daniel Haschtmann, Raluca Reitmeir, Markus Loibl, Dezsö Jeszenszky & Frank S. Kleinstück

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  1. Francine Mariaux
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Correspondence to Francine Mariaux.

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Mariaux, F., Elfering, A., Fekete, T.F. et al. The use of the Core Yellow Flags Index for the assessment of psychosocial distress in patients undergoing surgery of the cervical spine. Eur Spine J 33, 2269–2276 (2024). https://doi.org/10.1007/s00586-024-08190-0

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