Outcome scores in degenerative cervical disc surgery

Abstract

Forty-six consecutive patients with neck pain and arm radiculopathy were treated with anterior cervical discectomy and fusion. All patients had neurological symptoms corresponding to a herniated disc and/or spondylosis at one or two cervical levels, verified by magnetic resonance imaging. The patients were stabilized with an anterior graft and randomized to either fixation with a CSLP plate or no internal fixation. Preoperatively and 2 years postoperatively the patients filled in a questionnaire that included a modified Million Index, a modified Oswestry Index and the Zung Depression Scale. They were also asked to register their pain in the arm and in the neck on a vertical visual analogue scale (VAS). At the 2-year follow-up, an unbiased observer graded the patients' clinical outcome using Odom's criteria. A test-retest procedure was carried out to examine the questionnaire reproducibility. In the group that was operated at one level, there was no significant improvement in any of the scores. Nevertheless, 81% of the patients were satisfied with the outcome of the surgery. All scores improved in the group operated at two levels. The pain in the neck and arm, as measured on a VAS, decreased in both groups. The improvement in arm pain was significantly more pronounced in patients operated with a plate at two levels compared to those who were operated without a plate. At the 2-year follow-up, patients with an excellent or good result according to Odom's criteria had a lower Million Index (P < 0.0005), Oswestry Index (P < 0.0005), and Zung (P = 0.024) score, than the group classified as fair or poor. There was a significant correlation (P < 0.0001 for all scores) between the test and retest results. We conclude that the modified Million Index and Oswestry Index are clinically useful tools in the evaluation of outcome after degenerative cervical disc surgery. The clinical benefits of plate fixation were minimal. The outcome after surgery, measured with the Oswestry Index, Million Index and VAS for arm and neck pain, seems to correlate well with the classification of outcome by Odom.

Long-term randomised comparison between a carbon fibre cage and the Cloward procedure in the cervical spine

“…There are many retrospective reports on positive long-term effects of ACDF such as decreased pain, regression of neurological symptoms, and high rates of a satisfactory global outcome [2,7,9,10,14]. The present results are more modest and more in line with earlier prospective reports, confirming that retrospective studies have a tendency to overestimates outcomes [11,17,19,21,22,30].…”

“…In the combined total material, 61% of patients reported complete relief of problems or were much better, and 80% were satisfied with the results of surgery, which is in line with other global long-term results [9,10]. Interestingly, Zoe¨ga et al [30] reported that 81% of patients were satisfied with the results after one-level ACDF, despite no apparent improvement in pain or function. This is somewhat in agreement with our study, and verifies previous results showing that outcome is influenced by the method by which it is measured [11], and the relative nature of many outcome variables.…”

“…Similarly, Mayer et al [16] reported 47% of patients having abnormalities on Beck Depression Inventory one year after ACDF. Data suggesting even more depressed patients was reported by Zoe¨ga et al [30] who found no improvement of the depression index compared to preoperatively. Obviously, patients with degenerative cervical spine disorders often suffer from psychological distress, a factor that probably should be taken more into account in patient selection as well as in postoperative rehabilitation [30].…”

Investigation of clinically important benefit of anterior cervical decompression and fusion

“…Although several reports support this approach as effective [5,6,13], studies using patient-centered functional outcome measures [17,21,26,27,31,35,37] have shown poorer effectiveness, with substantial levels of residual symptoms (deficit) in subjective and objective evaluations [28][29][30]. Peolsson et al [28] found that approximately one third of their study patients had lingering disabilities in objective variables such as strength and range of motion 1 year after ACDF with a cervical intervertebral fusion cage (CIFC).…”

Effect of spa therapy after intervertebral disc surgery in the cervical spine

“…In spite of that, about 20 % of patients are not completely satisfi ed with the postoperative overall results (11,12) because of persisting diffi culties.…”