Anterior cervical discectomy, fusion have good outcomes for stenosis, herniation

Properly selected patients with discogenic pain can improve, but expectations need to be modified.

According to the results of a prospective, long-term study, anterior cervical discectomy and fusion is a good option for patients with arm symptoms due to stenosis or disc herniation.

“This study supports the long-term effectiveness of anterior cervical discectomy and fusion (ACDF) for patients with disc herniation and stenosis,” said Glenn R. Buttermann, MD, of Stillwater, Minn. “Neurologic deficits are typically improved. Properly selected patients with discogenic pain can also improve as a group, but expectations need to be modified.”

Previous physician-assessment studies have shown good results for patients with herniated discs and stenosis; however, there is a paucity of long-term, patient-based outcomes studies, he said.

“I think that having long-term patient-based outcomes studies can show the effectiveness of the treatments but also can serve as a baseline for new and upcoming treatments, such as long-term outcomes of disc replacement or other non-fusion technologies,” Buttermann told Orthopedics Today.

Timely research

These results are important because third-party payers want outcomes data, Buttermann said. “We need to justify that what we’re doing is helpful for the patients. In the past, it was physician-based outcomes, which may be perceived as a conflict of interest.”

The study included 159 patients who had ACDF with iliac crest bone graft for degenerative disc disease (55), disc herniation (52) and stenosis (52).

Patients had a minimum of 6 to 8 years follow-up, with many beyond 10 years, Buttermann said. Six patients were lost to follow-up.

Researchers categorized patients according to the number of levels treated, smoking history, pseudarthrosis development, worker’s compensation/litigation status and adjacent level degeneration. They used the neck and arm pain Visual Analog Scales, pain drawings, Oswestry Disability Index (ODI), narcotic use and overall patient opinion of treatment success to assess outcomes, he said.

The researchers used the same surgical technique in all cases.

Eighteen percent of patients had additional surgery for pseudarthrosis or ACDF extension for adjacent segment problems, Buttermann said. Nine percent of patients had ACDF extension for adjacent level issues.

“What was surprising to me was that women were two or three times more likely to have this problem than men,” Buttermann said.

All patients improved

All patient groups showed significant improvement in all outcomes and reported a similar reduction in neck pain, Buttermann said during his presentation. In the first year, the disc herniation and stenosis groups had significantly greater improvements than discogenic patients. Disc herniation patients had significantly greater improvements than discogenic and stenosis patients in the first 3 years.

Neither the number of levels fused nor the preoperative adjacent segment degeneration affected outcomes, he said.

Nonunions, smoking and unresolved workers’ compensation/litigation did affect outcomes.

“[These patients] still improved, but their improvement was only about half of that as patients who were non-workers’ comp and had a solid union,” Buttermann said.

For more information:
Glenn R. Buttermann, MD, can be reached at Midwest Spine Institute, 1950 Curve Crest Blvd, W. #100, Stillwater, MN 55082; 651-430-3800; e-mail: butte011@umn.edu. He receives research support for staff and materials from Abbott Spine, which did not fund this study.