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Duan Y, Feng D, Zou K, Yang F, Chen R, Huang Y. The Relationship Between Modic Changes and Endplate Sclerosis in Patients with Lumbar Degenerative Disease: A Systematic Review and Network Meta-Analysis. World Neurosurg 2024; 186:7-16. [PMID: 38479643 DOI: 10.1016/j.wneu.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/05/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To explore the relationship between modic changes (MCs) and endplate sclerosis in patients with lumbar degenerative disease. METHODS This network meta-analysis was performed on the basis of Preffered Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement. This study was registered at the International Prospective Register of Systematic Reviews (CRD42024497370). We performed a systematic search of the PubMed, Web of Science, Embase, China national knowledge infrastructure, China Science and Technology Journal Database, and Wanfang databases from inception to December 22, 2023. STATA13.0 and RevMan 5.3 were applied to perform the meta-analysis. RESULTS Seven studies with a total of 1510 endplates were divided into 6 groups according to the type of MCs. The endplate sclerosis rate in the single-type group was significantly lower than that in the mixed-type group. The endplate sclerosis rate in the type I MC (MC1) was significantly lower than that in the type II MC (MC2). The endplate sclerosis rate in the MC2 was significantly lower than that in the type III MC (MC3). The endplate sclerosis rate in the MC1/2 was significantly lower than that in the MC2/3. No significant difference was detected between MC1/2 and MC1/3 or between MC2/3 and MC1/3. For decreasing the endplate sclerosis rate, the order of the different types of MCs was MC1>MC2>MC1/2>MC2/3≈MC1/3>MC3. CONCLUSIONS Endplate sclerosis occurs in all kinds of MCs. With increasing grade of MCs, the incidence of endplate sclerosis gradually increased. The endplate sclerosis rate in mixed-type MCs was significantly greater than that in MC2 and significantly lower than that in MC3. The endplate sclerosis rate in the mixed-type, including MC3 (MC1/3 and MC2/3), was significantly greater than that in the MC1/2.
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Affiliation(s)
- Yuchen Duan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dagang Feng
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Kai Zou
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fei Yang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rigao Chen
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yong Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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Chen R, Zou K, Liu J, Li K, Zhou Y, Huang H, Yang F. Do modic changes affect the fusion rate in spinal interbody fusion surgery? A systematic review and network meta-analysis. J Clin Neurosci 2024; 125:110-119. [PMID: 38772174 DOI: 10.1016/j.jocn.2024.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/15/2024] [Indexed: 05/23/2024]
Abstract
OBJECTIVE To compare the fusion rates of spinal interbody fusion in patients with modic changes (MCs). METHODS This meta-analysis was registered at PROSPERO, and the project number was CRD42024538023. This network meta-analysis was conducted according to the PRISMA 2020 statement. The PubMed, Embase, Web of Science Core Collection, ClinicalTrials.gov and Cochrane Library databases were searched from inception to March 28, 2024 for potential studies. STATA 13.0 and Review Manager 5.3 were used to perform the meta-analysis. RESULTS Seven studies with a total of 1162 patients or segments assigned to four groups according to MCs grade were identified. The fusion rate in the non-modic changes (NMCs) was significantly greater than that in the MCs at the 3-month (p = 0.0001) and 6-month (p = 0.002) follow-ups. No significant difference was detected in the fusion rate at 12-month (p = 0.34) and final follow-ups (p = 0.41). No significant difference was found in cervical fusion (p = 0.88) or transforaminal lumbar interbody fusion (TLIF) (p = 0.51). The fusion rate of NMCs was significantly greater than that of MCs in posterior lumbar interbody fusion (PLIF) (p < 0.00001). No significant differences were identified among the four groups in the overall comparison, cervical fusion or TLIF subgroups. The fusion rate in the NMCs was significantly greater than that in the MCs-2 and MCs-3 in the PLIF. CONCLUSION MCs decreased the fusion rate at the 3- and 6-month follow-ups. MCs-2 and MCs-3 decrease the fusion rate in PLIF.
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Affiliation(s)
- Rigao Chen
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Kai Zou
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Jianjia Liu
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Ke Li
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Yi Zhou
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Haoyun Huang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Fei Yang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China.
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Muthu S, Diniz SE, Viswanathan VK, Hsieh PC, Abedi A, Yoon T, Meisel HJ, Buser Z, Rodrigues-Pinto R, Knowledge Forum Degenerative AS. What Is the Evidence Supporting Osteobiologic Use in Revision Anterior Cervical Discectomy and Fusion? Global Spine J 2024; 14:173S-178S. [PMID: 38421324 PMCID: PMC10913914 DOI: 10.1177/21925682221133751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE To analyze the literature and describe the evidence supporting osteobiologic use in revision anterior cervical discectomy and fusion (ACDF) surgery. METHODS A systematic search of PubMed/MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov databases was conducted for literature reporting the use of osteobiologics in revision ACDF. We searched for studies reporting outcomes of using any osteobiologic use in revision ACDF surgeries (independently of the number of levels) in the above databases. RESULTS There are currently no studies in the literature describing the outcome and comparative efficacy of diverse osteobiologic agents in the context of revision ACDF surgery. A majority of the current evidence is based only upon studies involving primary ACDF surgery. CONCLUSION The current study highlights the paucity of literature evidence on the role of diverse osteobiologics in revision ACDF, and foregrounds the need for high-quality evidence on this subject.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, India
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Sara Elisa Diniz
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Vibhu Krishnan Viswanathan
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Musculoskeletal Oncology, University of Calgary, Alberta, CA
| | - Patrick C Hsieh
- Department of Neurological Surgery, USC Spine Center, Keck School of Medicine, Los Angeles, CA, USA
| | - Aidin Abedi
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, USA
| | - Ricardo Rodrigues-Pinto
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal
- Hospital CUF Trindade, Porto, Portugal
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Lee DH, Park S, Seok SY, Cho JH, Hwang CJ, Kim IH, Baek SH. Fate of pseudarthrosis detected 2 years after anterior cervical discectomy and fusion: results of a minimum 5-year follow-up. Spine J 2023; 23:1790-1798. [PMID: 37487933 DOI: 10.1016/j.spinee.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND CONTEXT Prior study has shown that 70% of cervical pseudarthrosis after anterior cervical discectomy and fusion (ACDF) detected at 1 year will go on to fusion by 2 year. Pseudarthrosis detected 2 years after ACDF may have different bone healing potential compared to nonunion detected 1 year after surgery. Therefore, it might have a different clinical significance. PURPOSE To examine the radiographic and clinical prognosis of pseudarthrosis detected 2 years after ACDF with a minimum follow-up of 5 years. STUDY DESIGN/SETTING Retrospective cohort study. PATIENTS SAMPLE A total of 249 patients who completed a 5-year follow-up after ACDF. OUTCOMES MEASURES Clinical outcomes such as neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDI) and radiographic assessment such as X-ray, computed tomography (CT) scan. METHODS A total of 249 patients who completed a 5-year follow-up after ACDF were retrospectively reviewed. Patients who were diagnosed with pseudarthrosis at 2 years postoperatively were included. Fusion, neck pain VAS, arm pain VAS, and NDI were assessed. The results were compared between the union group (patients who achieved union), and the nonunion group (patients with pseudarthrosis) at 5 years postoperatively. RESULTS Among the patients who had pseudarthrosis at 2 years postoperatively, the fusion rate at 5 years was 32.6% (14/43). While the union group showed continued improvements in neck pain VAS, arm pain VAS, and NDI until 5 years, the nonunion group showed significant worsening of arm pain VAS and NDI at 5 years, with the values of neck pain VAS, arm pain VAS, and NDI being significantly worse than those of the union group at 5 years. CONCLUSION The incidence of pseudarthrosis detected at 2 years postoperatively after ACDF was 67.4%, and it remained unfused at 5 years postoperatively. Nonunion identified 2 years after ACDF may be considered a poor prognostic factor because it has less potential to achieve fusion with further follow-up and a higher chance of worsening clinical symptoms. Therefore, the presence of fusion at the 2-year follow-up can be considered an indicator of the success of the surgery.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yun Seok
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, University of Eulji College of Medicine, Daejeon, Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Hee Kim
- Department of Orthopedic Surgery, National police hospital, Seoul, Korea
| | - Seung Hyun Baek
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, University of Eulji College of Medicine, Daejeon, Korea.
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Bruchmann B, Kilian F. Follow-up of a new titanium cervical plate for fusion of the cervical spine. Orthop Rev (Pavia) 2023; 15:84651. [PMID: 37842541 PMCID: PMC10575764 DOI: 10.52965/001c.84651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Cervical plates are in use since the 1990ies for anterior cervical discectomy and fusion (ACDF). The latest step in development was a dynamic plate that allows sliding of the screws facilitating the natural settling of the bone after surgery. We investigated the clinical and radiological results of such a dynamic plate in a patient cohort that underwent single or multi-level ACDF for various cervical degenerative indications, including revision cases, from 2014 to 2019. Clinical and radiological outcome were assessed in 60 eligible patients after a mean of 2.9 years. The assessed neck disability index (NDI), and the visual analogue scale (VAS) of neck and arm pain show comparable results to the literature of ACDF, and specifically other plate designs. Forty-eight Adverse and Serious Adverse Events do not show a link to the product used. Clinical and radiological outcomes of ACDF with dynamic, third generation cervical plates show comparable results to the literature. Careful reporting of all Adverse Events revealed a variety of concomitant diseases, but could not be correlated to the implant used.
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Affiliation(s)
- Bernhard Bruchmann
- Katholisches Klinikum Koblenz - Montabaur, Brüderhaus Koblenz, Koblenz, Germany
| | - Francis Kilian
- Katholisches Klinikum Koblenz - Montabaur, Brüderhaus Koblenz, Koblenz, Germany
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Abstract
Pseudarthrosis of the cervical spine represents a common and challenging problem for spine surgeons. Rates vary greatly from as low as 0%-20% to >60% and depend heavily on patient factors, approach, and number of levels. While some patients remain asymptomatic from pseudarthrosis, many require revision surgery due to instability, continued neck pain, or radiculopathy/myelopathy. We aimed to provide a practical, narrative review of cervical pseudarthrosis to address the following areas: (1) definitions, (2) incidence, (3) risk factors, (4) presentation and workup, (5) treatment decision-making, and (6) postoperative care. It is our hope the current review provides a concise summary for how to diagnose and treat challenging cervical nonunions.
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Affiliation(s)
- Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Clinton J Devin
- Steamboat Orthopedic and Spine Institute, Steamboat Springs, CO
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Diagnosis of reoperated cervical non-union: Multicenter retrospective study about 45 patients. Orthop Traumatol Surg Res 2021; 107:102924. [PMID: 33845177 DOI: 10.1016/j.otsr.2021.102924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Non-union is one of the main complications of single- or multi-level cervical spine fusion, considerably impairing functional results. The aim of this study was to evaluate the respective contributions of imaging examinations in the diagnostic process, the challenge being to avoid inappropriate surgery and unnecessary complementary examinations. MATERIAL AND METHOD A retrospective multicenter study included all patients managed for cervical spine non-union between 2008 and 2018. We evaluated the imaging examinations performed on each patient and determined signs of non-union in each image. RESULTS The study included 45 patients in 4 centers: 55% female; mean age, of 48±8.0 years; 57% smokers. Systematic static radiography showed signs of non-union in 55% of cases. Dynamic X-ray was performed in 34% of patients, and showed hypermobility of the level in 80% of cases. CT supported diagnosis of non-union in 97% of cases, and MRI in 48%. SPECT-CT was positive in all cases of non-union. DISCUSSION Dynamic X-ray is rarely prescribed, but frequently provided an objective measure of hypermobility of the level in non-union, justifying first-line use. Millimetric-slice CT was reliable for diagnosis. MRI is relevant only once diagnosis has been made, as part of preoperative work-up. Nuclear imaging can be useful in order to solve doubtful cases. CONCLUSION In suspected cervical spine non-union, we recommend dynamic X-rays (flexion/extension) and CT-scan as first-line diagnosis examinations. LEVEL OF EVIDENCE IV.
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Comparison of Cost and Perioperative Outcome Profiles for Primary and Revision Posterior Cervical Fusion Procedures. Spine (Phila Pa 1976) 2021; 46:1295-1301. [PMID: 34517398 DOI: 10.1097/brs.0000000000004019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To compare perioperative outcomes and hospitalization costs between patients undergoing primary or revision posterior cervical discectomy and fusion (PCDF). SUMMARY OF BACKGROUND DATA While prior studies found differences in outcomes between primary and revision anterior cervical discectomy and fusion (ACDF), risk, and outcome profiles for posterior cervical revision procedures have not yet been elucidated. METHODS Institutional records were queried for cases involving isolated PCDF procedures to evaluate preoperative characteristics and outcomes for patients undergoing primary versus revision PCDF between 2008 and 2016. The primary outcome was perioperative complications, while perioperative and resource utilization measures such as hospitalization length, required stay in the intensive care unit (ICU), direct hospitalization costs, and 30-day emergency department (ED) admissions were explored as secondary outcomes. RESULTS One thousand one hundred twenty four patients underwent PCDF, with 218 (19.4%) undergoing a revision procedure. Patients undergoing revision procedures were younger (53.0 vs. 60.5 yrs), but had higher Elixhauser scores compared with the non-revision cohort. Revision cases tended to involve fewer spinal segments (3.6 vs. 4.1 segments) and shorter surgical durations (179.3 vs. 206.3 min), without significant differences in estimated blood loss. There were no significant differences in the overall complication rates (P = 0.20), however, the primary cohort had greater rates of required ICU stays (P = 0.0005) and non-home discharges (P = 0.0003). The revision cohort did experience significantly increased odds of 30-day ED admission (P = 0.04) and had higher direct hospitalization (P = 0.03) and surgical (P < 0.0001) costs. CONCLUSION Complication rates, including incidental durotomy, were similar between primary and revision PCDF cohorts. Although prior surgery status did not predict complication risk, comorbidity burden did. Nevertheless, patients undergoing revision procedures had decreased risk of required ICU stay but greater risk of 30-day ED admission and higher direct hospitalization and surgical costs.Level of Evidence: 3.
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Steinhaus ME, York PJ, Bronheim RS, Yang J, Lovecchio F, Kim HJ. Outcomes of Revision Surgery for Pseudarthrosis After Anterior Cervical Fusion: Case Series and Systematic Review. Global Spine J 2020; 10:559-570. [PMID: 32677569 PMCID: PMC7359693 DOI: 10.1177/2192568219863808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
STUDY DESIGN Case series/systematic review. OBJECTIVES To report on patients undergoing posterior cervical fusion for symptomatic pseudarthrosis following anterior cervical discectomy and fusion (ACDF), and to assess outcomes reporting in the literature. METHODS Patients undergoing posterior instrumented fusion for pseudarthrosis after primary ACDF from 2013 to 2018 by a single surgeon were reviewed consecutively. Neck Disability Index (NDI) and visual analogue scale (VAS) arm/neck were recorded at preoperative, 6-month, and 1-year time points. A systematic review of the literature was performed, and outcomes reporting was recorded. RESULTS NDI scores were 54.4 (SD 19.1), 36.6 (SD 18.1), and 41.2 (SD 19.2) at preoperative, 6-month, and 1-year time points, respectively, with improvement from preoperatively to 6 months (P = .004). VAS neck scores were 8.1 (SD 1.3), 5.0 (SD 2.9), and 5.8 (SD 2.2) at preoperative, 6-month, and 1-year time points, respectively, with improvement from preoperatively to 6 months (P = .038). VAS arm scores were 5.1 (SD 4.1), 3.5 (SD 3.2), and 3.6 (SD 2.7) at preoperative, 6-month, and 1-year time points, respectively, with improvement although these did not reach statistical significance (P = .145). The most common subjective outcomes reported in the literature were general symptoms assessments (43%), ordinal scales (43%), and VAS neck (19%) scales, with the majority of studies (67%) documenting one measure. CONCLUSIONS Patient-reported outcomes demonstrate clinically meaningful improvement within the first 6 months after posterior fusion for pseudarthrosis. Studies demonstrate substantial variability and no standardization in outcomes reporting, limiting the ability to compare results across interventions and pathologies. Standardized reporting will enable comparisons to inform patients and physicians on the optimal approach to treat this difficult problem.
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Affiliation(s)
| | | | | | - Jingyan Yang
- Hospital for Special Surgery, New York, NY, USA,Columbia University, New York, NY, USA
| | | | - Han Jo Kim
- Hospital for Special Surgery, New York, NY, USA,Han Jo Kim, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Laratta JL, Gupta K, Smith WD. Tissue-Sparing Posterior Cervical Fusion With Interfacet Cages: A Systematic Review of the Literature. Global Spine J 2020; 10:230-236. [PMID: 32206522 PMCID: PMC7076592 DOI: 10.1177/2192568219837145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVES Posterior cervical interfacet cages are an alternative to lateral mass fixation in patients undergoing cervical spine surgery. Recently, a percutaneous, tissue-sparing system for interfacet cage placement has been developed, however, there is limited clinical evidence supporting its widespread use. The aim was to review studies published on this system for patient reported outcomes, radiographic outcomes, intraoperative outcomes, and complications. METHODS Four electronic databases (PubMed, EMBASE, Scopus, and MEDLINE) were queried for original published studies that evaluated the percutaneous, tissue-sparing technique for posterior cervical fusion with interfacet cage placement. All studies reporting on open techniques and purely biomechanical studies were excluded. RESULTS The extensive literature search returned 7852 studies. After systematic review, a total of 7 studies met inclusion criteria. Studies were independently classified as retrospective or prospective cohort studies and each assessed by the GRADE criteria. Patient reported outcomes, radiographic outcomes, intraoperative outcomes, and complications were extracted from each study and presented. CONCLUSIONS Tissue-sparing, posterior cervical fusion with interfacet cages may be considered a safe and effective surgical intervention in patients failing conservative management for cervical spondylotic disease. However, the quality of evidence in the literature is lacking, and controlled, comparative studies are needed for definitive assessment.
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Affiliation(s)
- Joseph L. Laratta
- Norton Leatherman Spine Center, Louisville, KY, USA,University of Louisville Medical Center, Louisville, KY, USA,Joseph L. Laratta, Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY 40206, USA.
| | - Karishma Gupta
- Western Regional Center for Brain and Spine Surgery, Las Vegas, NV, USA
| | - William D. Smith
- Western Regional Center for Brain and Spine Surgery, Las Vegas, NV, USA
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Huang K, Hong Y, Liu H, Duan Y, Wang B, Chen H, Ding C, Rong X, Wu T. Is the bone fusion affected by Modic-2 changes in single-level anterior cervical discectomy and fusion? Medicine (Baltimore) 2020; 99:e18597. [PMID: 31895809 PMCID: PMC6946321 DOI: 10.1097/md.0000000000018597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To explore the impact of Modic changes (MCs) on bone fusion after single-level anterior cervical discectomy and fusion (ACDF) with a zero-profile implant (the Zero-P implant system).From November 2014 to November 2017, a total of 116 patients who underwent single-level ACDF with the Zero-P implant were divided into two groups according to MRI showing type 2 MCs (MC2) or no MCs (i.e., the MC2 group and the NMC group, respectively). A total of 92 (79.3%) patients were classified into the NMC group, and 24 (20.7%) patients were classified into the MC2 group. The clinical outcomes and fusion rates were retrospectively evaluated between the 2 groups preoperatively and postoperatively at 3, 6, and 12 months, and the final follow-up.The Japanese Orthopedic Association (JOA) scores and the visual analogue scale (VAS) scores of neck pain were significantly improved compared to the preoperative scores in both the NMC and MC2 groups (P < .05). However, there were no differences in JOA or VAS scores between the 2 groups (P > .05). The fusion rates of the NMC and MC2 groups at 3, 6, and 12 months postoperatively, and the final follow-up were 33.7% and 12.5%, 77.2% and 54.2%, 89.1% and 87.5%, and 97.8% and 95.8%, respectively. The fusion rates were significantly lower at 3 and 6 months after surgery in the MC2 group than in the NMC group (P < .05).The presence of MC2 did not affect the clinical outcome but delayed the fusion time following ACDF with the Zero-P implant system.Level of Evidence is Level 3.
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Affiliation(s)
| | - Ying Hong
- Department of Operation room, West China Hospital, Sichuan University, Chengdu Sichuan, China
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Cofano F, Sciarrone GJ, Pecoraro MF, Marengo N, Ajello M, Penner F, Petrone S, Ducati A, Zenga F, Musso C, Garbossa D. Cervical Interfacet Spacers to Promote Indirect Decompression and Enhance Fusion in Degenerative Spine: A Review. World Neurosurg 2019; 126:447-452. [PMID: 30904796 DOI: 10.1016/j.wneu.2019.03.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Among the posterior techniques, the use of cervical interfacet spacers (CISs) represents a promising technology whose potentialities are still being studied. The purpose of the present review was to assess the available data on CISs. METHODS A search on PubMed was performed. The search terms were "cervical interfacet spacers," "facet spacers," "DTRAX facet system," "Goel facet spacer," "pseudarthrosis," "cervical lordosis," "iatrogenic kyphosis," "cervical foraminal decompression," "cervical biomechanics," "atlantoaxial instability," and "subaxial instability." RESULTS Mechanical studies have shown that stand-alone CISs promoted stiffness in all directions, except for extension. Foraminal distraction was recorded in 86% of the cases. Clinical studies have shown that the use of CISs could promote successful arthrodesis, given the large surface area affected by fusion and decreasing the need for autografts. The effectiveness for the treatment of radiculopathy has been confirmed by several clinical studies. In a series of 154 levels of implanted CISs, no evidence of significant loss of cervical lordosis was identified. CISs could help in enhancing fusion in C1-C2 fixation. CONCLUSIONS Biomechanical studies on specimens showed a positive trend in increasing stiffness of the cervical spine, despite some controversial results. In clinical studies, facet distraction was shown to be a safe and valid option for clinical indirect decompression, although longer follow-up is required for confirmation. No evidence of the loss of cervical lordosis has been recorded. The long-term effects and CIS use in revision procedures as adjuvant implants to treat pseudarthrosis or atlantoaxial instability are currently under investigation, and further studies are needed.
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Affiliation(s)
- Fabio Cofano
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy.
| | | | | | - Nicola Marengo
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Marco Ajello
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federica Penner
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Salvatore Petrone
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Alessandro Ducati
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Francesco Zenga
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
| | - Corrado Musso
- Spinal Surgery, Humanitas Research Center, Bergamo, Italy
| | - Diego Garbossa
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Turin, Italy
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Alcoholism as a predictor for pseudarthrosis in primary spine fusion: An analysis of risk factors and 30-day outcomes for 52,402 patients from 2005 to 2013. J Orthop 2018; 16:36-40. [PMID: 30662235 DOI: 10.1016/j.jor.2018.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/09/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction This study assessed the incidence and risk factors for pseudarthrosis among primary spine fusion patients. Methods Retrospective review of ACS-NSQIP (2005-2013). Differences in comorbidities between spine fusion patients with and without pseudarthrosis (Pseud, N-Pseud) were assessed using chi-squared tests and Independent Samples t-tests. Binary logistic regression assessed patient-related and procedure-related predictors for pseudarthrosis. Results 52,402 patients (57yrs, 53%F, 0.4% w/pseudarthrosis). Alcohol consumption (OR:2.6[1.2-5.7]) and prior history of surgical revision (OR:1.6[1.4-1.8]) were risk factors for pseudarthrosis operation. Pseud patients at higher risk for deep incisional SSI (at 30-days:OR:6.6[2.0-21.8]). Pseud patients had more perioperative complications (avg:0.24 ± 0.43v0.18 ± 0.39,p=0.026). Conclusions Alcoholism and surgical revision are major risk factors for pseudarthrosis in patients undergoing spine fusion.
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Siemionow K, Smith W, Gillespy M, McCormack BM, Gundanna MI, Block JE. Length of stay associated with posterior cervical fusion with intervertebral cages: experience from a device registry. JOURNAL OF SPINE SURGERY 2018; 4:281-286. [PMID: 30069519 DOI: 10.21037/jss.2018.05.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Using a multi-center medical device registry, we prospectively collected a set of perioperative and clinical outcomes among patients treated with tissue-sparing, posteriorly-placed intervertebral cage fusion used in the management of symptomatic, degenerative neural compressive disorders of the cervical spine. Methods Cervical fusion utilizing posteriorly-placed intervertebral cages offers a tissue-sparing alternative to traditional instrumentation for the treatment of symptomatic cervical radiculopathy. A registry was established to prospectively collect perioperative and clinical data in a real-world clinical practice setting for patients treated via this approach. This study evaluated length of stay as well as estimated blood loss and procedural time in 271 registry patients. Results The median length of stay was 1.1, 1.1 and 1.2 days for patients having a stand-alone arthrodesis, revision of a pseudoarthrosis, and circumferential fusion (360°), respectively, and was not related to number of levels treated. Historical comparison to published literature demonstrated that average lengths of stay associated with open, posterior lateral mass fixation were consistently ≥4 days. Average blood loss (range, 32-75 mL) and procedural time (range, 51-88 min) were also diminished in patients having tissue-sparing, cervical intervertebral cage fusion compared to open posterior lateral mass fixation. Conclusions Adoption of this tissue-sparing procedure may offer substantial cost-constraining benefits by reducing the length of post-operative hospitalization by, at least, 3 days compared to traditional lateral mass fixation.
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Affiliation(s)
- Kris Siemionow
- Department of Orthopaedic Surgery, University of Illinois, Chicago, IL, USA
| | - William Smith
- Western Regional Center for Brain & Spine Surgery, Las Vegas, NV, USA
| | - Mark Gillespy
- Orthopaedic Clinic of Daytona Beach, Daytona Beach, FL, USA
| | - Bruce M McCormack
- Department of Neurosurgery, University of California, San Francisco, CA, USA
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Predictive Risk Factors of Nonhome Discharge Following Elective Posterior Cervical Fusion. World Neurosurg 2018; 119:e574-e579. [PMID: 30077022 DOI: 10.1016/j.wneu.2018.07.213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify risk factors that are predictive of nonhome discharge after elective posterior cervical fusion. METHODS We performed a retrospective cohort study of adult patients who underwent elective posterior cervical fusion using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2014. Patients were divided into 2 groups: home discharge and nonhome discharge. Univariate analysis was performed to compare incidence of 30-day postoperative complications between groups. Multivariate analysis was performed to identify complications that were predictive of nonhome discharge. RESULTS The cohort included 2875 patients; 24.1% were discharged to a nonhome facility, including skilled and nonskilled care facilities, nursing homes, assisted living facilities, and rehabilitation facilities. Nonhome discharge was associated with higher rates of 30-day pulmonary complication, cardiac complication, venous thromboembolism, urinary tract infection, blood transfusion, sepsis, and reoperation. Significant predictors of nonhome discharge were wound complication (odds ratio [OR] = 1.73; 95% confidence interval [CI], 1.07-2.80; P = 0.024), pulmonary complication (OR = 3.61; 95% CI, 1.96-6.63; P < 0.001), cardiac complication (OR = 6.13; 95% CI, 1.61-23.4; P = 0.008), venous thromboembolism (OR = 2.97; 95% CI, 1.43-6.19; P = 0.004), urinary tract infection (OR = 2.69; 95% CI, 1.50-4.82; P < 0.001), blood transfusion (OR = 1.70; 95% CI, 1.20-2.39; P = 0.003), sepsis (OR = 2.75; 95% CI, 1.25-6.02; P = 0.012), and prolonged length of stay (OR = 4.07; 95% CI, 3.34-4.95; P < 0.001). CONCLUSIONS Early identification of patients who are at high risk for nonhome discharge is important to implement early comprehensive discharge planning protocols and minimize hospital-acquired conditions related to prolonged length of stay and associated health care costs.
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Arshi A, Wang C, Park HY, Blumstein GW, Buser Z, Wang JC, Shamie AN, Park DY. Ambulatory anterior cervical discectomy and fusion is associated with a higher risk of revision surgery and perioperative complications: an analysis of a large nationwide database. Spine J 2018; 18:1180-1187. [PMID: 29155340 PMCID: PMC6291305 DOI: 10.1016/j.spinee.2017.11.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/02/2017] [Accepted: 11/07/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT With the changing landscape of health care, outpatient spine surgery is being more commonly performed to reduce cost and to improve efficiency. Anterior cervical discectomy and fusion (ACDF) is one of the most common spine surgeries performed and demand is expected to increase with an aging population. PURPOSE The objective of this study was to determine the nationwide trends and relative complication rates associated with outpatient ACDF. STUDY DESIGN/SETTING This is a large-scale retrospective case control study. PATIENT SAMPLE The patient sample included Humana-insured patients who underwent one- to two-level ACDF as either outpatients or inpatients from 2011 to 2016 OUTCOME MEASURES: The outcome measures included incidence and the adjusted odds ratio (OR) of postoperative medical and surgical complications within 1 year of the index surgery. MATERIALS AND METHODS A retrospective review was performed of the PearlDiver Humana insurance records database to identify patients undergoing one- to two-level ACDF (Current Procedural Terminology [CPT]-22551 and International Classification of Diseases [ICD]-9-816.2) as either outpatients or inpatients from 2011 to 2016. The incidence of perioperative medical and surgical complications was determined by querying for relevant ICD and CPT codes. Multivariate logistic regression adjusting for age, gender, and Charlson Comorbidity Index was used to calculate ORs of complications among outpatients relative to inpatients undergoing ACDF. RESULTS Cohorts of 1,215 patients who underwent outpatient ACDF and 10,964 patients who underwent inpatient ACDF were identified. The median age was in the 65-69 age group for both cohorts. The annual relative incidence of outpatient ACDF increased from 0.11 in 2011 to 0.22 in 2016 (R2=0.82, p=.04). Adjusting for age, gender, and comorbidities, patients undergoing outpatient ACDF were more likely to undergo revision surgery for posterior fusion at both 6 months (OR 1.58, confidence interval [CI] 1.27-1.96, p<.001) and 1 year (OR 1.79, CI 1.51-2.13, p<.001) postoperatively. Outpatient ACDF was also associated with a higher likelihood of revision anterior fusion at 1 year postoperatively (OR 1.46, CI 1.26-1.70, p<.001). Among medical complications, postoperative acute renal failure was more frequently associated with outpatient ACDF than inpatient ACDF (OR 1.25, CI 1.06-1.49, p=.010). Adjusted rates of all other queried surgical and medical complications were comparable. CONCLUSIONS Outpatient ACDF is increasing in frequency nationwide over the past several years. Nationwide data demonstrate a greater risk of perioperative surgical complications, including revision anterior and posterior fusion, as well as a higher risk of postoperative acute renal failure. Candidates for outpatient ACDF should be counseled and carefully selected to reduce these risks.
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Affiliation(s)
- Armin Arshi
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St., Santa Monica, CA 90404
| | - Christopher Wang
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1450 San Pablo St., Suite 5400, Los Angeles, CA, 90033
| | - Howard Y. Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St., Santa Monica, CA 90404
| | - Gideon W. Blumstein
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St., Santa Monica, CA 90404
| | - Zorica Buser
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1450 San Pablo St., Suite 5400, Los Angeles, CA, 90033
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, 1450 San Pablo St., Suite 5400, Los Angeles, CA, 90033
| | - Arya N. Shamie
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St., Santa Monica, CA 90404
| | - Don Y. Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St., Santa Monica, CA 90404,Corresponding author. Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th St. Suite 3142, Santa Monica, CA 90404. Tel.: (424) 259-9829., (D.Y. Park)
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Smith W, Gillespy M, Huffman J, Vong V, McCormack BM. Anterior Cervical Pseudarthrosis Treated with Bilateral Posterior Cervical Cages. Oper Neurosurg (Hagerstown) 2018. [PMID: 28637309 DOI: 10.1093/ons/opx103] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pseudarthrosis after anterior cervical discectomy and fusion (ACDF) causes persistent pain and related disability. Posterior revision surgery results in higher healing rates, but is more extensive compared to anterior surgery. OBJECTIVE To evaluate minimally disruptive, tissue sparing posterior fusion via bilateral placement of posterior cages between the facet joints as an alternative treatment option. METHODS A retrospective, multicenter, medical chart review was performed and included 25 patients with symptomatic pseudarthrosis after ACDF treated with posterior cervical cages, and in select cases, anterior revision. Visual analog scale (VAS) for neck and arm pain, Neck Disability Index (NDI), and perioperative metrics were collected. Fusion at 1 yr was determined via assessment of computed tomography (CT) scan and x-rays. RESULTS Mean follow-up was 18 mo. VAS neck and arm scores at last follow-up improved significantly from 7.9 ± 1.5 to 3.8 ± 2.3 and 7.24 ± 2.2 to 3.12 ± 2.5, respectively. NDI scores decreased from 65.1 ± 20.3 to 29.1 ± 17.9 at 18 mo. Fusion at 1 yr was confirmed by CT in all 17 patients with available scans and by x-ray in all 25 patients. CONCLUSION Revision of cervical pseudarthrosis after ACDF using a tissue sparing posterior approach to place cages bilaterally between the facet joints is an effective surgical strategy in select cases. Along with positive clinical and radiological outcomes, the procedure is associated with less blood loss, shorter operating times, and briefer hospital stays compared to revision with lateral mass fixation or interspinous wiring.
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Affiliation(s)
- William Smith
- Western Regional Center for Brain & Spine Surgery, Las Vegas, Nevada.,Department of Neurosurgery, University Medical Center, Las Vegas, Nevada
| | - Mark Gillespy
- Orthopaedic Clinic of Daytona Beach, Daytona Beach, Florida
| | - Jason Huffman
- Napa Valley Orthopaedics, 3273 Claremont Way, Napa, California
| | - Veasna Vong
- Bruce McCormack, Clinical Faculty, Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Bruce M McCormack
- Bruce McCormack, Clinical Faculty, Department of Neurosurgery, University of California San Francisco, San Francisco, California
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Preoperative Radiographic Parameters to Predict a Higher Pseudarthrosis Rate After Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976) 2017; 42:1772-1778. [PMID: 28459780 DOI: 10.1097/brs.0000000000002219] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine whether postoperative pseudarthrosis can be predicted from specific preoperative radiograph measurements. SUMMARY OF BACKGROUND DATA Various factors reportedly influence the occurrence of pseudarthrosis after anterior cervical discectomy and fusion (ACDF). However, to our knowledge, there are no reports on the relationships between preoperative radiographic parameters and pseudarthrosis. METHODS We analyzed 84 consecutive patients (45 males, 39 females, mean age, 58.9 ± 11.2 yrs) who underwent ACDF. In all patients, allografts filled with local chip bone were inserted after discectomy and anterior plating was performed. On preoperative plain radiographs, we analyzed C2-C7 sagittal vertical axis, T1 sagittal slope, segmental motion, global cervical motion, and location of fusion segments. Pseudarthrosis was diagnosed as interspinous motion >1 mm with superjacent interspinous motion ≥4 mm on magnified dynamic lateral radiographs. Multivariate logistic regression was used to analyze the risk factors for pseudarthrosis and the receiver operating characteristic (ROC) curve was used to define a cutoff value. RESULTS One hundred and twenty-five segments from 84 patients were included. The pseudarthrosis rate was 29% based on number of patients (24/84) and 20% based on number of segments (25/125). Multilevel surgery and segments at the lowest levels showed higher pseudarthrosis rates (P = 0.01). Per multivariate logistic regression analysis, greater preoperative segmental motion, greater preoperative T1 sagittal slope, and C6-7 segments were associated with a higher risk of pseudarthrosis (all P < 0.05). A segmental motion cutoff value of 12° demonstrated pseudarthrosis with sensitivity of 87%, specificity of 84%, and area under the curve of 0.899, indicating moderate accuracy. CONCLUSION Greater preoperative segmental motion, greater preoperative T1 sagittal slope, and lower fusion levels could be risk factors for pseudarthrosis following ACDF. Preoperative segmental motion >12° is likely to be an important indicator of the development of pseudarthrosis. LEVEL OF EVIDENCE 3.
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Giammalva GR, Iacopino DG, Maugeri R. Natura abhorret a vacuo. Future perspectives of autologous fibrin glue. Is it time for reappraisal? Surg Neurol Int 2017; 8:57. [PMID: 28540123 PMCID: PMC5421362 DOI: 10.4103/2152-7806.205262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/18/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Giuseppe R Giammalva
- Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, University Hospital, Palermo, Italy
| | - Domenico G Iacopino
- Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, University Hospital, Palermo, Italy
| | - Rosario Maugeri
- Department of Experimental Biomedicine and Clinical Neuroscience, Neurosurgical Unit, University Hospital, Palermo, Italy
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Impact of smoking on postoperative complications after anterior cervical discectomy and fusion. J Clin Neurosci 2017; 38:106-110. [DOI: 10.1016/j.jocn.2016.12.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/27/2016] [Indexed: 11/19/2022]
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Mayo BC, Massel DH, Bohl DD, Narain AS, Hijji FY, Long WW, Modi KD, Basques BA, Yacob A, Singh K. Preoperative mental health status may not be predictive of improvements in patient-reported outcomes following an anterior cervical discectomy and fusion. J Neurosurg Spine 2017; 26:177-182. [DOI: 10.3171/2016.7.spine16472] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Prior studies have correlated preoperative depression and poor mental health status with inferior patient-reported outcomes following lumbar spinal procedures. However, literature regarding the effect of mental health on outcomes following cervical spinal surgery is limited. As such, the purpose of this study is to test for the association of preoperative SF-12 Mental Component Summary (MCS) scores with improvements in Neck Disability Index (NDI), SF-12 Physical Component Summary (PCS), and neck and arm pain following anterior cervical discectomy and fusion (ACDF).
METHODS
A prospectively maintained surgical database of patients who underwent a primary 1- or 2-level ACDF during 2014–2015 was reviewed. Patients were excluded if they did not have complete patient-reported outcome data for the preoperative or 6-week, 12-week, or 6-month postoperative visits. At baseline, preoperative SF-12 MCS score was assessed for association with preoperative NDI, neck visual analog scale (VAS) score, arm VAS score, and SF-12 PCS score. The preoperative MCS score was then tested for association with changes in NDI, neck VAS, arm VAS, and SF-12 PCS scores from the preoperative visit to postoperative visits. These tests were conducted using multivariate regression controlling for baseline characteristics as well as for the preoperative score for the patient-reported outcome being assessed.
RESULTS
A total of 52 patients were included in the analysis. At baseline, a higher preoperative MCS score was negatively associated with a lower preoperative NDI (coefficient: −0.74, p < 0.001) and preoperative arm VAS score (−0.06, p = 0.026), but not preoperative neck VAS score (−0.03, p = 0.325) or SF-12 PCS score (0.04, p = 0.664). Additionally, there was no association between preoperative MCS score and improvement in NDI, neck VAS, arm VAS, or SF-12 PCS score at any of the postoperative time points (6 weeks, 12 weeks, and 6 months, p > 0.05 for each). The percentage of patients achieving a minimum clinically important difference at 6 months did not differ between the bottom and top MCS score halves (p > 0.05 for each).
CONCLUSIONS
The results of this study suggest that better preoperative mental health status is associated with lower perceived preoperative disability but is not associated with severity of preoperative neck or arm pain. In contrast to other studies, the present study was unable to demonstrate that preoperative mental health is predictive of improvement in patient-reported outcomes at any postoperative time point following an ACDF.
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