Effects of preoperative mental distress versus surgical modality, arthroplasty, or fusion on long-term outcome in patients with cervical radiculopathy

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Several efforts have been made to investigate the long-term efficacy of artificial disc replacement surgery compared with that of fusion after decompression for the treatment of cervical degenerative disc disease and radiculopathy. However, research on the impact of mental distress on surgical treatment outcome has been sparse. The aim of the authors was to investigate the potential predictive value of preoperative risk factors in determining long-term outcome.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A total of 153 patients (mean age 47 years) with single- or double-level cervical degenerative disc disease and radiculopathy were randomly assigned to undergo either anterior cervical discectomy and fusion (n = 70) or artificial disc replacement (n = 83). The primary outcome was the Neck Disability Index (NDI) score, a patient-reported function score that ranges from 0% to 100%; higher scores indicate greater disability. Preoperative variables such as sex, age, smoking status, employment status, having a strenuous job, neck pain duration, arm pain duration, amount of regular exercise, Hospital Anxiety and Depression Scale (HADS) score, NDI score, whether surgery was performed on 1 or 2 levels, and allocated treatment were analyzed in multiple linear regression models with the 5-year NDI score as the outcome.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 47 (31%) patients had either a HADS anxiety or HADS depression score of 10 points or higher. High values on the preoperative HADS were a negative predictor of outcome (p = 0.009). Treatment allocation had no effect on 5-year NDI scores (p = 0.32).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Preoperative mental distress measured with the HADS affects long-term outcome in surgically treated patients with cervical radiculopathy.</jats:p></jats:sec>

Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes

“…The most common levels at which patients received surgical treatment were C5-6 (n = 50, 33%), C6-7 (n = 50, 33%), or both (i.e., 2-level surgery, C5-7; n = 44, 29%). 17…”

“…This trial has been described previously, reporting the 2-year follow-up 29 and the predictors to 5-year outcomes. 17 Briefly, we conducted a multicenter randomized clinical superiority trial in which patients with cervical radiculopathy were randomly assigned to undergo either unconstrained ADR using the Discover artificial disc (DePuy Spine, Johnson & Johnson), or fusion using an autologous iliac crest graft and plate after decompression. We enrolled patients with cervical radiculopathy who were 25-60 years old and who met the following inclusion criteria: symptoms of radiating arm pain with duration of at least 3 months, correlating findings on MRI at one or two cervical levels, eligible for both treatments, and the ability to understand and read Swedish.…”

The effect of exercise on cervical radiculopathy

“…Cervical radiculopathy (CR), which is a normal result of degenerative changes such as cervical disc herniation and bone hyperplasia, is characterized by neck pain and radiating pain from the neck to the shoulder. [1] And significant functional limitations and disabilities are common presenting complaints for people suffering from CR, with a peak at 50 to 54 years of age, because of structurally and functionally causing neural inflammation, edema, hypoxia, ischemia, and so on. [2,3] A study from the US military found an incidence of 1.79 per 1000 person-years.…”

Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register

“…2,5,8,15,16,22,24 In fact, the outcome 5 years after surgical treatment for cervical radiculopathy has recently been discovered to be more dependent on preoperative mental distress, such as anxiety and depression, than the chosen surgical method, whether ADR or fusion. 12 The ADR group, however, had more perioperative complications, more secondary surgeries on the index level, and the same incidence of secondary surgery on adjacent levels compared with the fusion group. Hence, ADR surgery required more revisions and did not prevent progression of clinical ASP, one of the main arguments for the use of this device.…”