A study of postoperative outcomes of anterior cervical discectomy and fusion in CSM patients strati-fied by different symptom severity
Objective To explore clinical outcomes and improved social function on patients with different severity cervical spondylotic myelopathy(CSM)who underwent anterior cervical discectomy and fusion(ACDF).Methods A total of 198 patients undergoing initial ACDF(single or double level)for CSM in the Department of Orthopaedics in the First Affiliated Hospital of Zhengzhou University from Janu-ary 2017 to January 2023 were prospectively collected.According to Japanese orthopaedic association(JOA)scores,the patients were stratified into three groups:mild(＞13 points,52 cases),moderate(9-13 points,87 cases)and severe(＜9 points,59 cases).Neck pain(NP)and arm pain(AP)were evalua-ted by visual analogue scale(VAS).Postoperative neurological function was evaluated by JOA scales,neck disability index(NDI),physical component score(PCS),and mental component score(MCS).Minimal clinically important difference(MCID)was used to evaluate the clinical improvement for patients.The so-cial function satisfaction questionnaire was used to investigate the satisfaction degree of social function re-covery after operation.Calculating the return to work rate(RTWR)was used to evaluate social function.The data were statistically analyzed by ANOVA orx2 test or Fisher exact probability method.Results JOA scores[preoperative:(14.7±1.3),(10.9±2.6),(7.1±3.2),6 months after surgery:(15.9±1.4),(13.8±1.6),(12.3±2.9),1 year after surgery:(16.1±1.2),(14.4±1.9),(12.9±2.7),Ftime=76.724,P＜0.05]and PCS[preoperative:(41.9±15.4),(33.8±10.6),(26.7±9.8),6 months af-ter surgery:(49.3±17.2),(44.6±15.8),(37.9±12.6),1 year after surgery:(49.9±19.1),(47.4±17.1),(41.3±16.0),Ftime=96.219,P＜0.05]were increased,NDI[preoperative:(23.1± 16.3),(28.1±16.9),(46.3±18.5),6 months after surgery:(10.4±5.6),(15.3±8.2),(23.4± 15.7),1 year after surgery:(9.1±4.8),(12.7±6.6),(18.1±9.9),Ftime=109.747,P＜0.05],NP-VAS[preoperative:(3.5±1.6),(3.7±1.4),(3.6±1.5),6 months after surgery:(1.4±0.3),(1.3±0.4),(1.6±0.5),1 year after surgery:(0.9±0.4),(1.1±0.3),(1.1±0.4),Ftime=47.381,P＜0.05]and AP-VAS[preoperative:(2.9±2.0),(3.0±1.8),(2.8±1.9),6 months after surgery:(0.9±0.7),(1.3±0.6),(1.4±0.6),1 year after surgery:(0.8±0.6),(0.9±0.6),(1.1±0.5),Ftime=43.774,P＜0.05]scores were decreased in the three groups at 6 months and 1 year after surgery compared with those before surgery.In addition to the mild group,MCS in the moderate and severe groups were increased at 6 months and 1 year after surgery[before surgery:(45.1±10.3),(39.7±12.4),6 months after surgery:(49.9±10.7),(51.2±10.8),1 year after surgery:(51.1± 10.8),(51.4±11.2),Ftime=27.921,P＜0.05].There were no statistically significant differences in NP-MCID(x2=0.163,0.209,0.000,P＞0.05)and AP-MCID(x2=0.160,0.216,0.884,P＞0.05)among the three groups at 6 months and 1 year after surgery.Patients in the severe group had higher JOA-MCID at 1 year after surgery than 6 months after surgery(x2=3.997,P＜0.05).There were no sig-nificant differences between 1 year after surgery and 6 months after surgery for JOA-MCID in both the mild group and the moderate group(x2=0.000,0.473,P＞0.05).NDI-MCID(x2=3.994,4.266,4.470,P＜0.05)and PCS-MCID(x2=3.994,5.217,P＜0.05)of the 3 groups at 1 year after surgery were higher than those at 6 months after surgery(except for PCS-MCID in the severe group,x2=0.241,P＞0.05).In the mild group,moderate group and severe group,PCS-MCID increased successively,then pro-portion of patients with PCS-MCID was highest in the severe group(R=0.383,0.276,P＜0.05).At 6 months and 1 year after surgery,the satisfaction rates(R=-0.293,-0.202,P＜0.05)and RTWR(R=-0.153,-0.202,P＜0.05)of the patients were declined with the aggravation of disease.The sat-isfaction rates and RTWR of the severe group were the lowest,which were significantly lower than those of the mild group and the severe group.Conclusion Clinical outcomes and social function of CSM patients were improved after ACDF.The satisfaction rates and RTWR of the severe group were significantly lower than those of the mild group and the moderate group.
DiscectomyCervical spondylotic myelopathyAnterior cervical discectomy and fusionNeurological function
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NSTL
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