Prediction of outcome of anterior decompression and fusion for cervical disc disease

ABSTRACT

In a prospective study with a two year follow-up, 27 patients with cervical disc disease were randomized to anterior cervical decompression and fusion [ACDF]. Fixation by plate was done in 14 [51.8%] patients, in another group 13 patients [48.2%], no fixation has been done. The purpose of the present study was to report predictors for fusion and also to investigate the importance of radiographic variables for the clinical outcome. Gender, age, segmental kyphosis, disc hight and type of surgical procedure were used as independent variables. Male Gender, one level surgery, and fusion plus fixation by anterior cervical plate were significant predictors of healed fusion [P< 0.05]. Number of levels operated on, however did not influence the clinical outcome [P= 0.006]. Seventeen percent of the women and 12% of men in the first group [fusion plus plate fixation] and 18% of the women and 12% of the men in the second group [fusion without fixation], had pseudarthrosis. Patients with healed fusion had significantly less pain intensity than patients with pseudarthrosis. Neither degree of segmental kyphosis nor disc hight was different between patients with healed fusion and pseudarthrosis [P=01]. According to Odom's criteria [Bertalanffy and Eggert, 1988] the current study yielded excellent and good result in 90% in men and in 80% of women and resulted in excellent and good results in 92.8% in the first group [with plate fixation] compared to 84.5% in the second group [No plate fixation]. One can conclude that gender and type of surgery were significant predictors for a healed fusion and that pseudarthrosis affected the clinical outcome. On the other hand no effect on clinical outcome could be demonstrated for degree of segmental kyphosis and disc hight at follow-up. Overall, the study shows that the importance of radiological factors as predictors for fusion as well as clinical outcome is limited