• Francine Mariaux, Achim Elfering, Tamás F Fekete, François Porchet, Daniel Haschtmann, Raluca Reitmeir, Markus Loibl, Dezsö Jeszenszky, Frank S Kleinstück, and Anne F Mannion.
• Department of Teaching, Research and Development, Spine Centre Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland. Francine.mariaux@kws.ch.
• Eur Spine J. 2024 Jun 1; 33 (6): 226922762269-2276.

BackgroundPsychosocial 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.MethodsPatients 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.ResultsFrom 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).ConclusionThe 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.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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