Introduction: Anterior cervical discectomy and fusion is a common procedure utilized by surgeons to treat cervical spondylotic conditions, including radiculopathy and myelopathy. Its advantages over posterior approaches are numerous, including improved pain control postoperatively, improved sagittal balance alignment, and lower infection rates. Nevertheless, few prospective randomized controlled trials exist studying the true benefits of cervical surgery. This study evaluates a prospectively randomized placebo controlled database in context of outcomes related to fusion status.
Methods: From 2008-2012, a prospective, double blinded placebo-controlled trial was performed to evaluate the effects of dexamethasone in management of airway edema and fusion rates. Patient-reported outcomes were collected at regular intervals with fusion being assessed at 6-months and 12-months, with SF-12 surveys, VAS, Oswestry scores, and myelopathy scores. Data was then divided into two groups at the six and twelve-month intervals to fused patients versus unfused patients, and outcome measures were analyzed.
Results: At the six-month mark, no outcome measure proved significantly different between the fused and unfused patients with myelopathy, though there were trends that should be noted. First, swallowing scores were better in the unfused groups, though this may result from confounding with dexamethasone usage. It should also be noted that the visual analog score of right arm pain was slightly better in the fused group, though not achieving significance. At the 12-month mark, there were no significant differences in any of the outcome measures.
Conclusions: In this blinded, randomized, placebo-controlled study, patient-reported outcome measures involving functionality and pain were not significantly affected by fusion-status. This supports the use of dexamethasone for airway edema as its inhibitory effect towards fusion appears to lack clinical differences. Furthermore, this study may place emphasis on the decompression behind cervical surgery rather than fusion, and that nonunion may not be of significant concern in otherwise healthy postoperative patients.
Patient Care: To put in perspective fusion as an outcome measure in anterior cervical procedures in context of its clinical outcomes with regard to myelopathy.
Learning Objectives: To evaluate the clinical impact of fusion in ACDF procedures