Factors affecting functional outcome after anterior cervical discectomy and fusion
Alba Scerrati, Antonino Germanò, Nicola Montano, Jacopo Visani, Fabio Cacciola, Giovanni Raffa, Ilaria Ghetti, Fabrizio Pignotti, Michele Alessandro Cavallo, Alessandro Olivi, Pasquale De Bonis
Abstract
Background: Although anterior cervical discectomy and fusion (ACDF) represents a standardized procedure for surgical treatment of a cervical herniated disc, several variables could affect patients' clinical and radiological outcome. We evaluated the impact of sex, age, body mass index (BMI), myelopathy, one- or two-level ACDF, and the use of postoperative collars on functional and radiological outcomes in a large series of patients operated for ACDF. Materials and Methods: Databases of three institutions were searched, resulting in the enrollment of 234 patients submitted to one- or two-level ACDF from January 2013 to December 2017 and followed as outpatients at 6- and 12-month follow-up. The impact of variables on functional and radiological outcomes was evaluated using univariate and multivariate logistic regression analysis. Results: At univariate analysis, female sex, higher BMI, two-level ACDF, and postoperative collar correlated with a significantly worse early and late Neck Disability Index (NDI). Multivariate analysis showed that male patients had a lower risk of worse early ( P = 0.01) and late NDIs ( P = 0.009). Patients with myelopathy showed better early NDI ( P = 0.004). Cervical collar negatively influenced both early and late NDIs ( P < 0.0001), with a higher risk of early nonfusion ( P = 0.001) but a lower risk of late nonfusion ( P = 0.01). Patients operated for two-level ACDF have a worse early NDI ( P = 0.005), a worse late NDI ( P = 0.01), and a higher risk of early nonfusion ( P = 0.048). BMI and age did not influence outcome. Conclusions: Female sex, two-level surgery, and the use of postoperative collars significantly correlate with worse functional outcomes after one- or two-level ACDF.