Comparison of surgical outcomes after anterior cervical discectomy and fusion: does the intra-operative use of a microscope improve surgical outcomes.
BACKGROUND
The primary aim of this study was to assess and compare the complications profile as well as long-term clinical outcomes between patients undergoing an Anterior Cervical Discectomy and Fusion (ACDF) procedure with and without the use of an intra-operative microscope.


METHODS
One hundred and forty adult patients (non-microscope cohort: 81; microscope cohort: 59) undergoing ACDF at a major academic medical center were included in this study. Enrollment criteria included available demographic, surgical and clinical outcome data. All patients had prospectively collected patient-reported outcomes measures and a minimum 2-year follow-up. Patients completed the neck disability index (NDI), short-form 12 (SF-12) and visual analog pain scale (VAS) before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts.


RESULTS
Baseline characteristics were similar between both cohorts. The mean ± standard deviation duration of surgery was longer in the microscope cohort (microscope: 169±34 minutes vs. non-microscope: 98±42 minutes, P<0.001). There was no significant difference between cohorts in the incidence of nerve root injury (P=0.99) or incidental durotomy (P=0.32). At 3 months post-operatively, both cohorts demonstrated similar improvement in VAS-neck pain (P=0.69), NDI (P=0.86), SF-12 PCS (P=0.84) and SF-12 MCS (P=0.75). At 2-year post-operatively, both the microscope and non-microscope cohorts demonstrated similar improvement from base line in NDI (microscope: 13.52±25.77 vs. non-microscope: 19.51±27.47, P<0.18), SF-12 PCS (microscope: 4.15±26.39 vs. non-microscope: 11.98±22.96, P<0.07), SF-12 MCS (microscope: 9.47±32.38 vs. non-microscope: 16.19±30.44, P<0.21). Interestingly at 2 years, the change in VAS neck pain score was significantly different between cohorts (microscope: 2.22±4.00 vs. non-microscope: 3.69±3.61, P<0.02).


CONCLUSIONS
Our study demonstrates that the intra-operative use of a microscope does not improve overall surgery-related outcomes, nor does it lead to superior long-term outcomes in pain and functional disability, 2 years after index surgery.
Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA ;
Owoicho
O
Adogwa
Duke University School of Medicine, Durham, NC, USA ;
Aladine
A
Elsamadicy
University of Alabama in Birmingham, Birmingham, AL, USA ;
Elizabeth
E
Reiser
Duke University School of Medicine, Durham, NC, USA ;
Cole
C
Ziegler
Duke University School of Medicine, Durham, NC, USA ;
Kyle
K
Freischlag
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA ;
Joseph
J
Cheng
Department of Neurosurgery, University of Texas Southwestern, Dallas, TX, USA.
Carlos A
CA
Bagley
Surgical outcomes; anterior cervical discectomy and fusion (ACDF); cervical spine; intra-operative microscope; patient-reported outcomes
Neurosci J. 2014;2014:808596
26317110
Neurosurg Focus. 2014 Jun;36(6):E1
24881633
Eur J Orthop Surg Traumatol. 2015 Jul;25 Suppl 1:S87-100
24791930
Head Neck. 2010 Feb;32(2):154-9
19536761
Eur Spine J. 2007 Sep;16(9):1411-6
17262184
Spine (Phila Pa 1976). 1998 Jan 15;23 (2):188-92
9474724
J Neurosurg. 1975 Oct;43(4):452-6
1159482
Zentralbl Neurochir. 2008 Aug;69(3):113-24
18666050
Surg Neurol. 2000 Apr;53(4):340-6; discussion 346-8
10825519
ANZ J Surg. 2013 Apr;83(4):211-4
23331506
Spine (Phila Pa 1976). 2006 Apr 15;31(8):897-902
16622378
Spine (Phila Pa 1976). 1996 Sep 15;21(18):2123-9; discussion 2129-30
8893437
Spine (Phila Pa 1976). 2002 Nov 15;27(22):2431-4
12435970
J Neurosurg. 1958 Nov;15(6):602-17
13599052
J Am Med Assoc. 1958 Jan 4;166(1):23-8
13491305
Spine (Phila Pa 1976). 2003 Jun 15;28(12 ):1219-24; discussion 1225
12811263