Can the results 6 months after anterior cervical decompression and fusion identify patients who will have remaining deficit at long-term?
OBJECTIVE
There is no knowledge if short-term outcome in patients after anterior cervical decompression and fusion (ACDF) can be used to identify which patients have remaining deficit in long term. This study investigates if 6-month outcome with a broad assessment after ACDF with a cervical intervertebral fusion cage can be a guide for the 3-years outcome.


METHODS
A prospective study. Questions about background data, pain, numbness, neck specific disability, distress, sick leave, health, symptom satisfaction and effect of and satisfaction with surgery were asked 28 patients 3 years after ACDF. Measurements have earlier been obtained before and 6 and 12 months after ACDF.


RESULTS
Compared with the results before surgery patients had improved in pain intensity (p = 0.001), neck pain (0.001), numbness (p = 0.02) and were more 'satisfied' with having their neck problems (p = 0.01). Except for a worsening in expectations of surgery fulfilled (p = 0.04) there were no significant differences between 6-month and 3-year outcome. Three years after ACDF about two-thirds of the patients had remaining deficit with regard to pain intensity, Neck Disability Index, Distress and Risk Assessment Method and general health. According to the parameters studied 50 - 78% of those who at the 6-month follow-up were without deficit were still healthy at the 3-year follow-up. For patients with deficit at 6-month follow-up, still 83 - 100% had deficit 3 years after surgery.


CONCLUSIONS
Despite a rather small study obtained the stability of 6-month and 3-year results indicates that short-term results might be sufficient for evaluating effects of the treatment. Since the patients in this study clearly demonstrate broad problems array of development of more structured multi-professional rehabilitation models including exercises which improve neck muscle strength, endurance and proprioception need to be introduced.
Peolsson
Anneli
A
Department of Health and Society, Division of Physiotherapy, Faculty of Health Sciences, Linköping University, Sweden. Anneli.Peolsson@ihs.liu.se
Vavruch
Ludek
L
Oberg
Birgitta
B
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery; D019299:Decompression, Surgical / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology; D017116:Low Back Pain / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000453:epidemiology; D017060:Patient Satisfaction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011843:Radiculopathy / Q000534:rehabilitation* / Q000601:surgery; D020127:Recovery of Function; D018582:Sick Leave; D013123:Spinal Fusion / Q000534:rehabilitation*; D016896:Treatment Outcome