Incidence and Risk Factors for Pulmonary Embolism Following Spinal Fusion Surgery Exceeding Six Hours: Dynamic Risk Stratification Using a Two-Stage Predictive Model

Clinical outcomes in patients with cervical radiculopathy due to a herniated cervical disc remain difficult to predict following conservative or surgical treatment.Identifying sociodemographic factors associated with patient-reported outcomes may improve clinical decision-making, expectation management, and support personalized treatment strategies.This study evaluated whether educational attainment is associated with clinical outcomes in cervical radiculopathy.Methods: Data were derived from the CASINO trial, a multi-center observational cohort study.Highest completed educational attainment was recorded at baseline and categorized intro four groups: (1) no or primary education, (2) upper secondary or vocational education, (3) general upper secondary education, and (4) college or university level.Clinical outcomes included Visual Analogue Scale (VAS) for arm and neck pain, Neck Disability Index (NDI), and EuroQol VAS, assessed at baseline and at 6, 12, 26, 38, 52, and 104 weeks.Linear mixed-effects models with a random intercept were used, adjusted for age, gender, and body mass index.Results: The cohort included 28, 60, 15, and 38 patients in groups 1-4, respectively.Baseline arm pain, neck pain, NDI, and EurQol VAS scores were comparable between educational categories.Over time, patients with no or primary education showed significantly worse recovery in arm pain compared with the upper secondary or vocational education group (mean difference 13.0, p=0.017), the general upper secondary education group (mean difference 15.8, p=0.040), and the college/university education group (mean difference 17.8, p=0.002).Moreover, the no or primary education group reported higher neck pain (mean difference 8.96, p=0.044) and lower self-reported health scores (mean difference -10.6, p=0.042), compared with the college or university group.Conclusions: Patients with no or primary education experience more arm pain than the other education groups.Differences in pain perception and challenges in independently performing selfmanagement strategies may contribute to these disparities.