Prediction of fusion and importance of radiological variables for the outcome of anterior cervical decompression and fusion
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In a prospective randomised study with a 2-year follow-up, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage (CIFC) or the Cloward procedure (CP). The purpose of the present study was to report predictors for fusion and also to investigate the importance of radiological variables for the clinical outcome. Gender, age, smoking habits, disc height, segmental kyphosis and type of surgical procedure were used as independent (before surgery) variables in a multiple regression model. Male gender, one-level surgery and CP treatment were significant predictors of fusion and explained 14% of the variability of fusion status at follow-up. Number of levels operated on, however, did not influence the clinical outcome. Fifty-two per cent of the women and 17% of the men in the CIFC group, and 25% of the women and 8% of the men in the CP group, had pseudarthrosis. Although patients with a healed fusion had significantly less pain intensity than patients with pseudarthrosis, radiological variables explained only 4% of the variability of pain at follow-up. Apart from a significant correlation between preoperative kyphosis and neck disability index at follow-up, no significant correlation between either postoperative kyphosis or preoperative or postoperative disc height and clinical outcome was found. Neither degree of segmental kyphosis nor disc height was different between patients with healed fusion and pseudarthrosis. One can conclude that male gender and type of surgery were significant predictors for a healed fusion and that pseudarthrosis affected outcome. In contrast to the commonly held view based mainly on theoretical considerations, no effect on clinical outcome could be demonstrated for segmental kyphosis and disc height at follow-up. Overall, the study shows that the importance of radiological factors as predictors for fusion as well as clinical outcome is limited.
KeywordsPredisposing factors Treatment outcome Radiology Radiculopathy Surgery
The study received financial support from the Faculty of Health Sciences at Linköping University.
- 2.Bertalanffy H, Eggert HR (1988) Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy: a follow-up of 164 cases. Acta Neurochir 90:127–135Google Scholar
- 3.Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. J Bone Joint Surg 75A:1298–1307Google Scholar
- 4.Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–614Google Scholar
- 6.Eriksen EF, Buhl M, Fode K, Klaerke A, Krøyer L, Lindeberg H, Madsen CB, Strange L, Wohlert L, Espersen JO (1984) Treatment of cervical disc disease using Cloward’s technique: the prognostic value of clinical preoperative data in 1,106 patients. Acta Neurochir 70:181–197Google Scholar
- 7.Gillings D, Koch G (1991) The application of the principle of intention-to-treat to the analysis of clinical trials. Drug Inf J 25:411–424Google Scholar
- 14.Linovitz RJ, Pathria M, Bernhardt M, Green D, Law MD, McGuire RA, Montesano PX, Rechtine G, Salib RM, Ryaby JT, Faden JS, Ponder R, Muenz LR, Magee FP, Garfin SA (2002) Combined magnetic fields accelerate and increase spine fusion: a double-blind, randomized, placebo controlled study. Spine 27:1383–1389CrossRefPubMedGoogle Scholar
- 16.Odom GL, Finney W (1958) Cervical disk lesions. JAMA 166:23–28Google Scholar
- 23.Tabachnik B, Fidell L (1996) Using multivariate statistics. Harper Collins College Publishers, New YorkGoogle Scholar