Research Fellow Hospital for Special Surgery Hospital for Special Surgery
Introduction: While anterior cervical discectomy and fusion (ACDF) is a reliable and efficacious treatment option for degenerative cervical spine pathology, not all patients undergoing ACDF will experience improvement. The factors associated with non-improvement after ACDF have not been well evaluated. The objective of the present study was to evaluate clinical and demographic factors associated non improvement following ACDF.
Methods: Clinical, demographic, and radiographic data were collected and measured from patient’s electronic medical record. Outcome measures for this study included global rating change “non-betterment” and minimal clinically important difference achievement rates for NDI, VAS-Neck, and VAS-Arm at both early and late postoperative periods were assessed based on previously established thresholds. Multivariate logistic regressions were performed for each PROM and evaluation period, with failure to achieve betterment assigned as the outcome variable.
Results: A total of 214 patients were included in the analysis. GRC non betterment was predicted by surgery at C7T1 (OR=1.32), myelopathy (OR=1.09) or myeloradiculopathy (OR=1.10) diagnosis, low superficial extensor muscle health at C2C3 (OR=1.22), and low deep flexor muscle health at C2C3 (OR=0.88). NDI MCID non achievement at long term follow up was predicted by smoking status (OR=1.26), symptom duration >6m (OR=1.12), and high preoperative NDI (OR=0.89). VAS-Arm MCID non achievement at long term follow up was predicted by myelopathy (OR=1.24) or myeloradiculopathy (OR=1.17) diagnosis, surgery at C3C4 (OR=1.17), and predominant neck (OR=1.42) or equal neck/arm pain (OR=1.19), Asian race (OR=0.68), and low superficial extensor muscle health at C5C6 (OR=1.22). VAS-Neck MCID non achievement at long term follow up was predicted by myelopathy diagnosis (OR=1.30), age greater than 50 (OR=1.15), and Asian race (OR=0.66).
Conclusion : Our study identified several risk factors and protective factors associated with improvement or non-improvement after ACDF. These findings may help inform the approach to counseling patients on outcomes of ACDF prior to surgery.