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. 2018 Mar;10(3):268-276.
doi: 10.14740/jocmr3326w. Epub 2018 Jan 26.

Correlation of Clinical and Radiological Outcome After Anterior Cervical Discectomy and Fusion With a Polyetheretherketone Cage

Savvas L Spanos  1   2 , Ioannis D Siasios  3   4   5 , Vassilios G Dimopoulos  3   4 , Konstantinos N Paterakis  1 , Dimos S Mastrogiannis  6 , Theofanis P Giannis  7 , Aggeliki A Fotiadou  1 , John Pollina  3   4 , Kostas N Fountas  1   7
Affiliations

Correlation of Clinical and Radiological Outcome After Anterior Cervical Discectomy and Fusion With a Polyetheretherketone Cage

Savvas L Spanos et al. J Clin Med Res. 2018 Mar.

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) with a polyetheretherketone (PEEK) cage is considered as the gold standard for patients with cervical disc disease. However, there are limited in vivo data on the impact of ACDF on the cervical kinematics and its association with patient-reported clinical outcomes. The purpose of this study was to investigate the impact of altered cervical sagittal alignment (cervical lordosis) and sagittal range of motion (ROM) on patients' self-reported pain and functional disability, after ACDF with a PEEK cage.

Methods: We prospectively studied 74 patients, who underwent single-, or consecutive two-level ACDF with a PEEK interbody cage. The clinical outcomes were assessed by using the pain numeric rating scale (NRS) and the neck disability index (NDI). Radiological outcomes included cervical lordosis and C2-C7 sagittal ROM. The outcome measures were collected preoperatively, at the day of patients' hospital discharge, and also at 6 and 12 months postoperatively.

Results: There was a statistically significant reduction of the NRS and NDI scores postoperatively at each time point (P < 0.005). Cervical lordosis and also ROM significantly reduced until the last follow-up (P < 0.005). There was significant positive correlation between NRS and NDI preoperatively, as well as at 6 and 12 months postoperatively (P < 0.005). In regard to the ROM and the NDI scores, there was no correlation preoperatively (P = 0.199) or postoperatively (6 months, P = 0.322; 12 months, P = 0.476). Additionally, there was no preoperative (P = 0.134) or postoperative (6 months, P = 0.772; 12 months, P = 0.335) correlation between the NDI scores and cervical lordosis.

Conclusions: In our study, reduction of cervical lordosis and sagittal ROM did not appear to significantly influence on patients' self-reported disability. Such findings further highlight the greater role of pain level over the mechanical limitations of ACDF with a PEEK cage on patients' own perceived recovery.

Keywords: Anterior cervical discectomy and fusion; Cervical ROM; Cervical lordosis; Neck disability index; Numeric rating scale; PEEK cage; Pain.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Line graphs illustrating: (a) the pain NRS mean scores and (b) the NDI mean scores preoperatively and then at 6- and 12-month time points. There was significant difference between time points for both instruments.
Figure 2
Figure 2
Line graphs illustrating C2-C7 ROM for the single- and two-level ACDF groups preoperatively and then at 6- and 12-month time points. There was significant difference between time points for both conditions.
See this image and copyright information in PMC

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