Anterior discectomy and fusion for the management of neck pain

Abstract

Study design: Data were collected prospectively on 38 patients who underwent anterior cervical discectomy and fusion for neck pain with no symptoms or signs of radiculopathy or myelopathy.

Objectives: To determine the changes in pain and function after anterior cervical discectomy and fusion for nonradicular neck pain.

Summary of background data: There is considerable controversy regarding the role of anterior cervical discectomy and fusion for neck pain in the absence of radiculopathy or myelopathy. Although no studies have addressed this specific and common problem, it is known that anterior cervical discectomy and fusion for radiculopathy or myelopathy may also provide relief of neck pain for many patients.

Methods: Thirty-eight patients who underwent anterior cervical discectomy and fusion for neck pain were evaluated. Before and after surgery, the authors measured pain with a numerical rating scale, function with the Oswestry Disability Questionnaire, and final patient satisfaction. Final evaluation was done by a disinterested third party.

Results: All 38 patients were available for follow-up study. Mean age was 42.4 years, and mean duration of follow-up study was 53 months. All patients had painful disc(s) proven by discography. No patients had nerve root compression. Anterior cervical discectomy and fusion was performed at one level in 21 patients, two levels in 16 patients, and three levels in one patient. The mean score on the numerical rating scale for neck pain before surgery was 8.3 (range, 3-10) versus 4.1 (range, 0-10) after surgery. This difference is significant (P < 0.001). The mean score on the Oswestry Disability Questionnaire was 57.5 (range, 0-89) before surgery versus 38.9 (range, 0-80) after surgery. This difference is significant (P < 0.001). There were 30 (79%) patients who were satisfied with their outcome, and 8 (21%) who were not satisfied. There was no statistical difference in change of pain or function between patients with worker's compensation and those with other insurance or between men and women. Twenty patients were not working because of neck pain before surgery, and 15 were not working at the time of follow-up examination.

Conclusion: A significant decrease in pain, a significant increase in function, and a high degree of patient satisfaction were found with anterior cervical discectomy and fusion for neck pain. Improvements were not affected by worker's compensation status or gender.