A more than 20-year follow-up of pain and disability after anterior cervical decompression and fusion surgery for degenerative disc disease and comparisons between two surgical techniques

Anna Hermansen; Rune Hedlund; Peter Zsigmond; Anneli Peolsson

doi:10.1186/s12891-023-06503-w

A more than 20-year follow-up of pain and disability after anterior cervical decompression and fusion surgery for degenerative disc disease and comparisons between two surgical techniques

BMC Musculoskelet Disord. 2023 May 22;24(1):406. doi: 10.1186/s12891-023-06503-w.

Authors

Anna Hermansen¹, Rune Hedlund², Peter Zsigmond³, Anneli Peolsson⁴

Affiliations

¹ Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Building 511, Entrance 76, Level 15, Linköping, SE-581 83, Sweden. anna.hermansen@liu.se.
² Aleris Ortopedi, Nacka Specialistsjukhus, Stockholm, Sweden.
³ Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden and Department of Neurosurgery, Region Östergötland, Linköping, Sweden.
⁴ Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping, Sweden; Occupational and Environmental Medicine Centre and Department of Health, Medicine and Caring Sciences, Unit of Clinical Medicine, Linköping University, Linköping, Sweden.

Abstract

Background: Follow-ups more than 20 years after neck surgery are extremely rare. No previous randomized studies have investigated differences in pain and disability more than 20 years after ACDF surgery using different techniques. The purpose of this study was to describe pain and functioning more than 20 years after anterior cervical decompression and fusion surgery, and to compare outcomes between the Cloward Procedure and the carbon fiber fusion cage (CIFC).

Methods: This study is a 20 to 24-year follow-up of a randomized controlled trial. Questionnaires were sent to 64 individuals, at least 20 years after ACDF due to cervical radiculopathy. Fifty individuals (mean age 69, 60% women, 55% CIFC) completed questionnaires. Mean time since surgery was 22.4 years (range 20,5-24). Primary outcomes were neck pain and neck disability index (NDI). Secondary outcomes were frequency and intensity of neck and arm pain, headache, dizziness, self-efficacy, health related quality of life or global outcome. Clinically relevant improvements were defined as 30 mm decrease in pain and a decrease in disability of 20 percentage units. Between-group differences over time were analyzed with mixed design ANOVA and relationships between main outcomes and psychosocial factors were analyzed by Spearman´s rho.

Results: Neck pain and NDI score significantly improved over time (p < .001), with no group differences in primary or secondary outcomes. Eighty-eight per cent of participants experienced improvements or full recovery, 71% (pain) and 41% (NDI) had clinically relevant improvements. Pain and NDI were correlated with lower self-efficacy and quality of life.

Conclusion: The results from this study do not support the idea that fusion technique affects long-term outcome of ACDF. Pain and disability improved substantially over time, irrespective of surgical technique. However, the majority of participants reported residual disability not to a negligible extent. Pain and disability were correlated to lower self-efficacy and quality of life.

Keywords: Cervical intervertebral fusion cage; Cloward procedure; Disability; Long-term follow-up; Pain.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Cervical Vertebrae / surgery
Decompression
Diskectomy / methods
Female
Follow-Up Studies
Humans
Intervertebral Disc Degeneration* / surgery
Male
Neck Pain / etiology
Neck Pain / surgery
Quality of Life
Spinal Fusion* / adverse effects
Spinal Fusion* / methods
Treatment Outcome