Predictive Factors of Clinically Relevant Improvement After Anterior Cervical Decompression and Fusion: 10- to 13-Year Follow-Up

Journal of Neurosurgery

Hermansen et al. report long-term results of a prospective, randomized study evaluating ACDF outcomes. Clinically relevant improvement (CRI) was defined as ≥ 30-mm improvement on a visual analog scale and ≥ 20% improvement in the neck disability index from preoperative measurements at 10-year follow-up. A total of 73/95 patients completed questionnaires 10 years after ACDF: 46 had surgery at 1 level, 24 patients at 2 levels, and 3 patients at 3 levels. High preoperative neck-related pain intensity and preoperative nonsmoking status were predictors of good outcomes. No additional predictive factors were identified. The number of operated levels and presence of fusion did not influence outcomes. Individuals without improvement in neck-specific disability and pain intensity reported worse psychosocial outcomes compared with the improved group. At 10-year follow-up, women reported significantly greater neck and arm-related pain intensity than men, and women also reported more disability and worse psychosocial status. This study is consistent with previous reports suggesting preoperative predictive factors of good ACDF outcome include initial high neck-related pain intensity and nonsmoking status at surgery.

John H. Shin, MD
Boston, MA