Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10- to 13-year follow-up of a prospective randomized study Clinical article

Hermansen, Anna, Hedlund, Rune, Vavruch, Ludek and Peolsson, Anneli (2013) Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10- to 13-year follow-up of a prospective randomized study Clinical article. Journal of Neurosurgery: Spine, 19 4: 403-411. doi:10.3171/2013.7.SPINE12843


Author Hermansen, Anna
Hedlund, Rune
Vavruch, Ludek
Peolsson, Anneli
Title Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10- to 13-year follow-up of a prospective randomized study Clinical article
Journal name Journal of Neurosurgery: Spine   Check publisher's open access policy
ISSN 1547-5654
1547-5646
Publication date 2013-10-01
Year available 2013
Sub-type Article (original research)
DOI 10.3171/2013.7.SPINE12843
Open Access Status Not Open Access
Volume 19
Issue 4
Start page 403
End page 411
Total pages 9
Place of publication Rolling Meadows, IL, United States
Publisher American Association of Neurological Surgeons
Language eng
Formatted abstract
OBJECT
The main purpose of this 10- to 13-year follow-up of a prospective randomized study was to identify preoperative factors that predicted good long-term outcome after anterior cervical decompression and fusion (ACDF) with the Cloward procedure or the cervical intervertebral fusion cage. A second purpose was to investigate subgroup differences at the 10-year follow-up between patients with and without clinically relevant improvement (CRI) and between men and women.

METHODS
To evaluate clinically meaningful outcomes, good outcome was defined as CRI in neck-related pain intensity (≥ 30-mm improvement on a visual analog scale), and CRI in neck-specific disability (≥ 20% improvement in the neck disability index [NDI]) from preoperative measurements to the 10-year follow-up. A total of 73 patients (77% of the original study sample) completed questionnaires at least 10 years after ACDF.

RESULTS
High preoperative neck-related pain intensity and preoperative nonsmoking status were predictors of CRI in neck-related pain intensity, and male sex was a predictor of CRI in neck-specific disability; however, no additional predictive factors were identified for good outcome after ACDF. The surgical procedure, number of operated levels, and radiological factors such as healing status did not influence the prediction models. Individuals without CRI in neck-specific disability (75%) and pain intensity (43%) reported a worse outcome for several psychosocial outcome variables compared with those with CRI. At the 10-year follow-up, women reported significantly greater neck- and arm-related pain intensity than men, and women also reported more disability and worse psychosocial status. Women reported CRI on the NDI less frequently than men (p = 0.01).

CONCLUSIONS
Preoperative predictive factors of good outcome 10–13 years after ACDF included initial high neck-related pain intensity, nonsmoking status at the time of surgery, and male sex. There were greater improvements in pain intensity than in neck-specific disability, and the latter showed a greater association with psychosocial factors. These results suggest the need for multimodal postoperative rehabilitation for patients who do not have a satisfactory outcome after ACDF.
Keyword Cervical disc disease
Radiculopathy
Anterior cervical fusion
Clinical relevant outcome
Prognostic factors
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Health and Rehabilitation Sciences Publications
 
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