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Use the DASH to Evaluate Upper Extremity Involvement in Cervical Spine Surgery?

by Elizabeth Hofheinz, M.P.H., M.Ed., November 29, 2019

How does a 30-item patient reported outcome measure—the Disabilities of the Arm, Shoulder, and Hand (DASH)—compare to the Visual Analog Scale (VAS) for pain, and neck disability index (NDI) in patients undergoing cervical spine surgery?

New research on this topic, “Validation of the Disabilities of the Arm, Shoulder, and Hand in Patients Undergoing Cervical Spine Surgery,” appears in the December 1, 2019 edition of Spine.

Co-author Wilson Z. Ray, M.D., Associate Professor of Neurological and Orthopedic Surgery and Vice Chair in the Division of Neurosurgery, told OSN, “I take care of both peripheral nerve injury patients and spine patients and several years ago we observed an overlap of symptoms/complaints between cervical radiculopathies and patients with brachial plexus injuries. We felt the DASH may be a good instrument to better capture the disabilities associated with upper extremity dysfunction experienced by cervical myelopathy/radiculopathy patients.”

The authors stated, “Neck-specific disability scales do not adequately assess concurrent upper extremity involvement in patients with cervical spine disorders. The DASH is a patient-reported outcomes (PRO) instrument designed to measure functional disability due to upper extremity conditions but has additionally been shown to perform well in patients with neck disorders.”

Examining 1,046 patients who underwent cervical spine surgery at the Washington University School of Medicine in St. Louis, the researchers found that the most common procedure was anterior cervical discectomy and fusion. They wrote, “Patients experienced clinically meaningful postoperative improvements in all PRO measures. The DASH showed moderate positive correlations with VAS preoperatively, as well as early and late postoperatively. DASH and NDI scores were strongly positively correlated across operative states.”

Dr. Ray commented to OSN, “The DASH represents both a valid and responsive patient reported outcome measure to evaluate disabling upper extremity involvement in patients undergoing cervical spine surgery. From a practical standpoint, I believe this provides the most utility in cervical radiculopathy vs myelopathy pre- and post-op. DASH represents a valuable patient reported outcome metric that correlates with upper extremity response to cervical spine surgery, particular cervical radiculopathy.”

Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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