A Retrospective Analysis of Patient Perceived Outcomes in Patients 55 Years and Older Undergoing Anterior Cervical Discectomy and Fusion

Gray, Matthew; Biyani, Ashok; Smith, Asher

doi:10.1097/bsd.0b013e31819e31a4

Cited by 15 publications

(6 citation statements)

References 18 publications

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“…There are studies that demonstrate than in a short term follow up posterior decompression has better results compared with an anterior approach, but in a longer follow up no differences were found. 17,20,21 Our study had several limitations. The patients were not randomized to the surgical procedure they underwent.…”

Section: Discussionmentioning

confidence: 95%

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Clinical outcome of anterior vs posterior approach for cervical spondylotic myelopathy

Cahueque

Cobar

Muciño

et al. 2016

Journal of Orthopaedics

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The term cervical spondylotic myelopathy (CSM) was published in 1952, Brain et al. discovered the neurological signs and symptoms associated to medullar lesions secondary to vascular compromise. 1 CSM is caused by the chronic compression of neurological elements, which together with spinal canal stenosis by ossification of the posterior longitudinal ligament forms the 2 most frequent causes of CSM. Patients with progressive neurological deterioration have surgical treatment indication, 50-75% will show neurological recovery in the first 6 months follow-up. 2,3 The choice of treatment in CSM can be anterior, posterior or combined approaches. The decision to choose an approach will depend on important factors: the cause of neurological compression (anterior structures, posterior structures or both), the number of affected segments, sagittal cervical balance and the surgeons experience in the surgical approach. Traditionally the anterior compression pathologies, either by disc herniation or bone spur formation in the posterior wall of the vertebral body, have been managed by anterior approach with corpectomy and fusion or discoidectomy and fusion. When there are 2 or 3 segments affected the posterior approach is recommended with laminectomy or laminoplasty. Realizing anterior approach, when there are 2 or more segments affected, raises the risk of no-union, stress in adjacent segments, cervical degeneration is augmented and swallowing can be difficult. 2,4 Regarding cervical sagittal balance, there is evidence that the anterior approach offers better results than the posterior approach. There are various scales available to measure neurological function in patients with SCM, of which the most relevant are the modified Japanese Orthopedic Association scale and Nurick's scale (Tables 1 and 2). These scales can be used to evaluate results in neurological function after a posterior and anterior cervical decompression, comparing them at 1.4-year follow-up (Table 3). 2,4-6

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Section: Discussionmentioning

confidence: 95%

“…The follow-up period is short, so we believe that patients with anterior decompression show a clinical improvement at 2 years, as reported in other studies. [19][20][21] …”

Section: Discussionmentioning

confidence: 98%

Clinical outcome of anterior vs posterior approach for cervical spondylotic myelopathy

Cahueque

Cobar

Muciño

et al. 2016

Journal of Orthopaedics

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“…According to Aragones et al, the improvements in NDI and VAS scores are significantly better with arthroplasty than with arthrodesis (29,37) . The results of Li et al showed that although ACDR resulted in a lower rate of adjacent segment degeneration and subsequent corrective surgeries in less than 7 years after the primary surgery, ACDR patients had similar NDI and VAS scores to those of ACDF (31) .…”

Section: Discussionmentioning

confidence: 99%

“…It has been documented that the conventional cervical surgical technique, namely ACDF surgery, causes improvements in NDI and VAS (29) . Some studies examined outcomes of fusion patients (30)(31)(32)(33)(34) , whereas others compared fusion with arthroplasty (15,16,26,28,(35)(36)(37) .…”

Section: Discussionmentioning

confidence: 99%

Long-Term Functional and Symptomatic Outcomes of Cervical Disc Prostheses

Aydın¹,

Üçer²,

Bozkurt³

2020

İKSST

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Objective: Cervical disc arthroplasty aims preservation of motion at the operated level while minimizing degenerative disease at adjacent levels. This study aimed to examine the long-term functional outcomes of patients with cervical disc pathology who were operated with arthroplasty technique. Method: Sixty-eight patients who underwent cervical disc prosthesis implantation for disc herniation or spondylosis were included. Functional outcomes over time were evaluated using Neck Disability Index (NDI) and visual analogue scale (VAS) at baseline and 6 months, 1 year, 2 years, 4 years and 7 years after surgery. Results: Mean duration of follow-up was 5.4±1.8 years (median, 7 y; range, 1-7 y). At the last follow-up visit, VAS and NDI scores were significantly lower compared to baseline (1.2±0.9 vs. 7.7±1.2, p<0.001 and 5.5±5.0 vs. 40.4±5.8, p<0.001, respectively). VAS and NDI scores were improved at all measured time points compared to baseline (p<0.001 for all comparisons). A plateau was reached at 2 years and at 1 year for VAS and NDI scores, respectively. The overall predefined surgical success rate was 86.8% at the last follow-up. Conclusion: Findings of this study supports the benefit of cervical dynamic disc systems in cervical disc surgery in terms of functional outcomes both in the short-term after surgery and in the long term.

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“…We elected to look at anterior cervical discectomy and fusion (ACDF) given that it is one of the most common spinal procedures performed, with a well-established surgical approach, high success rate, consistent operative time, and predictable length of hospital stay, as well as high variability in operating room costs. [5][6][7]…”

Section: Introductionmentioning

confidence: 99%

Association Between Physician Industry Payments and Cost of Anterior Cervical Discectomy and Fusion in Medicare Beneficiaries

Liu

Ahmed²,

Chen

et al. 2020

World Neurosurgery

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BACKGROUND Neurosurgical spine specialists receive considerable amounts of industry support which may impact the cost of care. The aim of this study was to evaluate the association between industry payments received by spine surgeons and the total hospital and operating room (OR) costs of an anterior cervical discectomy and fusion (ACDF) procedure among Medicare beneficiaries. METHODS All ACDF cases were identified among the Medicare Carrier Files, from January 1, 2013, to December 31, 2014, and matched to the Medicare Inpatient Baseline File. The total hospital and OR charges were obtained for these cases. Charges were converted to cost using year-specific cost-to-charge ratios. Surgeons were identified among Open Payments database, which is used to quantify industry support. Analyses was performed to examine the association between industry payments received and ACDF costs. RESULTS Matching resulting in the inclusion of 2,209 ACDF claims from 2013-2014. In 2013 and 2014, the mean total cost for an ACDF was 21, 798and21,008, respectively; mean OR cost was 5, 878and6,064, respectively. Mann-Whitney U test demonstrated no significant differences in the mean total or OR cost for an ACDF based on quartile of general industry payment received (p=0.21 and p=0.54), and linear regression found no association between industry general payments, research support, or investments on the total hospital cost (p=0.41, p=0.13, and p=0.25), or OR cost for an ACDF (p=0.35, p=0.24, and p=0.40). CONCLUSIONS This study suggests that spine surgeons performing ACDF surgeries may receive industry support without impacting the cost of care.

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A Retrospective Analysis of Patient Perceived Outcomes in Patients 55 Years and Older Undergoing Anterior Cervical Discectomy and Fusion

Abstract: On the basis of our statistically significant improvement in NDI and SF-36 scores, as a measure of patient perceived outcome after ACDF surgery, outcomes after ACDF surgery in patients over 55 years of age are not significantly different than those of a younger patient population.

Cited by 15 publications

References 18 publications

Clinical outcome of anterior vs posterior approach for cervical spondylotic myelopathy

Clinical outcome of anterior vs posterior approach for cervical spondylotic myelopathy

Long-Term Functional and Symptomatic Outcomes of Cervical Disc Prostheses

Association Between Physician Industry Payments and Cost of Anterior Cervical Discectomy and Fusion in Medicare Beneficiaries

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