Cervical Spine Sagittal Alignment and clinical outcome after Anterior Cervical Discectomy and Fusion

PUBLISHED: Am J Orthop (Belle Mead NJ). 2012 Jun;41(6):E81-4. Referenced Pub Med:

AUTHORS: Gum JL, Glassman SD, Douglas LR, Carreon LY.

Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.

BACKGROUND: Studies have shown that maintenance of lordosis improves outcomes after anterior cervical discectomy and fusion (ACDF).

The relationship between maintenance or restoration of lordosis after ACDF and health-related quality of life (HRQOL) measures has not been evaluated.  Preoperative and 2-year postoperative cervical lordosis (C2-C7) and segmental lordosis were measured from upright lateral cervical spine radiographs in patients who had ACDF.

Data on the Neck Disability Index (NDI), Short- Form-36 Physical Composite Summary Score, arm, and neck pain scores were also collected. Paired t-tests were used to compare preoperative and 2-year postoperative radiographic measures and HRQOL measures. Receiver operating characteristic curves were constructed to identify sagittal parameters that predict achievement of a Minimum Clinically Important Difference (MCID) in outcome measures.

METHODS: One hundred one patients (75 female; mean age, 52 years) were included. There was improvement in all HRQOL measures from preoperative to 2 years postoperative. There was no significant difference in preoperative and 2-year postoperative sagittal alignment.

RESULTS: Receiver operating characteristic curve analysis showed that a postoperative cervical lordosis of at least 6° predicted achievement of MCID for NDI (8 point change in NDI).

This suggests that maintenance or restoration of overall cervical lordosis is important in achieving a successful result after Anterior Cervical Discectomy and Fusion (ACDF).

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