title: Integrated outcome assessment after anterior cervical discectomy and fusion: myelocompression but not adjacent instability affect patient-reported quality of life and cervical spine symptoms.
abstract: METHODS
  The authors conducted a cross-sectional study.
  
  
  OBJECTIVE
  Integrated assessment of adjacent instability (AI), myelocompression (MC), magnetic resonance imaging (MRI) signs of myelopathy (MRISM), physician-assessed clinical signs and symptoms, including clinical signs of myelopathy (CSM), patients' self-reported symptoms and quality of life after anterior cervical discectomy and fusion (ACDF).
  
  
  METHODS
  Fifty-four patients who had ACDF between 1986 and 1995 received MRI scans, conventional and flexion/extension radiographs to assess myelocompression, MRISM, fusion, and AI. Clinical outcome was assessed using signs and symptoms based on selected items of Odom's criteria, Oswestry low back pain disability questionnaire, and the neck disability index. Patients reported their quality of life (QL) on a standardized instrument (Profiles of QL of Chronically Ill [PLC]) and by a specific validated Cervical Spine Symptom Scale (CSSS).
  
  
  RESULTS
  Myelocompression was found more frequently than expected (24%). MRISM were seen in 2 patients (4%). One of the 2 patients developed CSM. Fusion was achieved in 94% (with kyphosis in 17%). AI was found in 30%. However, only myelocompression but not AI was associated with statistically significant decreases in most QL scores (i.e., everyday capabilities, positive mood) and high cervical spine symptom burden (all P's < 0.05).
  
  
  CONCLUSIONS
  The study results underline the need for a better understanding of the biomechanical changes in the adjacent unfused segments. Consensus is needed on postoperative follow-up guidelines, including pain management strategies. Future studies on the outcome of ACDF will profit from an integrated outcome approach, including assessments based on imaging, physicians, and patients.
authors.affiliation: Department of Orthopedic Surgery, Philipps University Marburg, Germany. heino.kienapfel@vivantes.de
authors.forename: Heino
authors.initials: H
authors.lastname: Kienapfel
authors.forename: Michael
authors.initials: M
authors.lastname: Koller
authors.forename: David
authors.initials: D
authors.lastname: Hinder
authors.forename: Christian
authors.initials: C
authors.lastname: Georg
authors.forename: Michael
authors.initials: M
authors.lastname: Pfeiffer
authors.forename: K J
authors.initials: KJ
authors.lastname: Klose
authors.forename: Wilfried
authors.initials: W
authors.lastname: Lorenz
authors.forename: Peter
authors.initials: P
authors.lastname: Griss
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D003430:Cross-Sectional Studies; D017586:Diskectomy / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011859:Radiography; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000706:statistics & numerical data; D016896:Treatment Outcome