Predictive factors for the outcome of anterior cervical decompression and fusion.
In a prospective study, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage or the Cloward procedure. Preoperative background variables, active range of neck motion, handgrip strength, radiological evaluation and subjective variables were used in a multiple regression model to find the strongest predictors of postoperative outcome as measured by current pain intensity and the Neck Disability Index (NDI). Male sex, greater kyphosis at the level operated on, non-smoking, a greater neck mobility in right rotation, low disability on NDI, and older age were predictors of pain reduction and explained 30% of current pain intensity at follow-up. Higher educational level, non-smoking, greater kyphosis at the level operated on, a greater flexion mobility, greater right handgrip strength and lower current pain intensity were predictors of improvement, and explained 28% of the postoperative outcome on NDI. The most important predictor for postoperative pain intensity was the magnitude of the preoperative kyphosis. Preoperative pain intensity was the most important predictor for improved NDI. At follow-up about 70% of the patients still had deficit based on current pain intensity and NDI, and 44% had remaining dysfunction based on Odom's criteria. In conclusion, the multivariate analysis shows that male sex, non-smoking, greater segmental kyphosis and a low pain and disability level are preoperative predictors of a good outcome in ACDF. In addition, the study suggests the importance of other predictive variables than those studied for the outcome of ACDF.
Peolsson
Anneli
A
Department of Health and Society, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, 58185 Linköping, Sweden. Anneli.Peolsson@ihs.liu.se
Hedlund
Rune
R
Vavruch
Ludek
L
Oberg
Birgitta
B
D000367:Age Factors; D015984:Causality; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007738:Kyphosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D011859:Radiography; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D016896:Treatment Outcome