Anterior cervical discectomy and fusion in young adults leads to favorable outcome in long-term follow-up

Hirvonen, Tuomas; Siironen, Jari; Marjamaa, Johan; Niemelä, Mika; Koski-Palkén, Anniina

doi:10.1016/j.spinee.2020.03.016

Cited by 16 publications

(20 citation statements)

References 33 publications

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“…At present, ACDF is still the rst-line surgical method for the treatment of CDDD, and its surgical effect has been con rmed by clinical application for decades [1][2][3][8][9][10] . The treatment of CDDD focuses on relieving neurological symptoms and reconstructing the spinal structure [15][16][17]. The ways to relieve neurological symptoms are similar, which mainly depend on the operator's operation and experience.…”

Section: Discussionmentioning

confidence: 99%

Over-correction of Curvature in Surgical Segments Cause the Non-surgical Curvature Loss in One- and Two-level Anterior Cervical Discectomy and Fusion

Guo

Líu

Yang

et al. 2021

Preprint

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Background: In some patients with anterior cervical disecetomy anf fusion (ACDF), the correction degree of cervical curvature after surgery is less than that of the surgical segment curvature, which we defined as non-surgical curvature loss (NSCL). This study aims to elucidate the notification of NSCL and its possible causes. Methods: A retrospective analysis was conducted on 122 patients with one- or two-level ACDF from October 2012 to June 2017. The pre-operative and post-operative Cobb angle of C2-7, surgical segments and non-surgical segments were measured and analyzed by lateral cervical X-ray. Results: All patients were followed up for 22.87±3.15 months. Both one- and two-level ACDF could improve the cervical curvature. In the evaluation of NSCL, it was found that the incidence was 37.50% (27/72) in one-level ACDF and 48.00% (24/50) in two-level ACDF. Furthermore, the NSCL does not spontaneously recover after surgery. By comparing patients with and without NSCL, it was found that patients with NSCL had a significantly higher correction degree in the surgical segments, while the degree of NSCL was significantly and positively correlated with the correction degree of the surgical segments. For patients with a slight correction degree of surgical segment, the cervical curvature was well-improved and maintained post-operatively. Conclusion: In summary, the correction of the surgical segment curvature in ACDF should not be overemphasized, because excessive correction may cause NSCL. Even if the surgical segment curvature is only slightly corrected, a good improvement in cervical curvature can still be attained.

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Section: Discussionmentioning

confidence: 99%

Over-correction of Curvature in Surgical Segments Cause the Non-surgical Curvature Loss in One- and Two-level Anterior Cervical Discectomy and Fusion

Guo

Líu

Yang

et al. 2021

Preprint

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“…Most previous studies have been conducted in unrestricted age groups. In our previous study [1] concentrating on patients operated on under the age of 40, the estimate for the annual incidence of ASD requiring surgery was 1.1% in a median 17.5 years of follow-up time. Patients operated on at a young age have a long life expectancy and a long number of working years ahead of them.…”

Section: Introductionmentioning

confidence: 99%

“…Cervical radiculopathy can be caused by either intervertebral disc herniation or spondylotic nerve root compression. Among younger patients, disc herniation is the most common cause [1]. The leading surgical treatment of cervical radiculopathy is anterior cervical discectomy and fusion (ACDF).…”

Section: Introductionmentioning

confidence: 99%

“…While degenerative spine disorders are overall progressive in nature, it has also been widely proposed that the ACDF procedure may even accelerate the degeneration of adjacent cervical discs, leading to so-called adjacent segment disease (ASD). The total incidence of ASD has been evaluated to be 2.9%/year [4], the incidence of ASD requiring surgery at 0.8−2.4%/year [1,5,6], and the lifetime risk of postoperative ASD up to 25.5% [4]. Most previous studies have been conducted in unrestricted age groups.…”

Section: Introductionmentioning

confidence: 99%

“…We previously investigated the long-term results and need for further cervical surgeries in patients operated on for intervertebral disc herniation or spondylotic nerve root compression with ACDF under the age of 40 [1]. The total reoperation rate for further cervical surgeries (with acute revision surgeries excluded) during the entire follow-up period (12−28 years, median 17 years) was 19.5%, and the 10-year reoperation rate was 12.8%.…”

Section: Introductionmentioning

confidence: 99%

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Young adults undergoing ACDF surgery exhibit decreased health-related quality of life in the long term in comparison to the general population

et al. 2021

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BACKGROUND CONTEXT: The leading surgical treatment of cervical radiculopathy is anterior cervical discectomy and fusion (ACDF). However, it has been suggested that ACDF procedures could lead to accelerated degeneration of the adjacent cervical discs (adjacent segment disease, or ASD) and the effect of ACDF surgery on neck symptoms and quality of life in the long term is not fully understood. Patients operated on at young ages generally have a long life expectancy and a long number of working years ahead of them. Thus, this patient group is of special interest when considering the accumulation of cervical problems due to possible ASD, the overall progressive nature of cervical degeneration in the long term, and their effects on related quality of life. PURPOSE: Our goal was to study the health-related quality of life in the long-term follow-up after ACDF surgery in the young adult population between the ages of 18 and 40. STUDY DESIGN: A retrospective cohort study with propensity matched controls. PATIENT SAMPLE: All patients between 18 and 40 years of age at the time of the surgery who underwent ACDF due to degenerative cervical disease at Helsinki University Hospital between the years 1990 and 2005 who had filled in the quality of life questionnaires 12 to 28 years after the surgery (281 patients), and a propensity matched control cohort of the general population selected based on age, sex, and smoking status. OUTCOME MEASURES: Quality of life measured by the EuroQol questionnaire (EQ-5D-3L and EQ-VAS). METHODS: The medical records of all patients who underwent ACDF due to degenerative cervical disease at the age of 18 to 40 years at Helsinki University Hospital between 1990 and 2005 were analyzed retrospectively. The EuroQol questionnaire was sent to all patients whose contact information could be obtained (443 patients) at the end of the follow-up (median 17.5 years) to assess their current quality of life. A total of 281 patients returned the questionnaires and were included in this study. Quality of life was compared to that in the general Finnish population using a similar sized control cohort selected through propensity matching. RESULTS: The patients who had undergone ACDF surgery reported significantly more problems than the general population cohort in three out of five dimensions that were assessed in the EQ-5D questionnaire, including mobility, usual activities, and pain/discomfort. Similarly, the overall EQ-5D-3L index calculated from the dimensional values was lower (0.74 vs. 0.83, p=.000), depicting a generally decreased health-related quality of life among patients. Spondylosis as a primary diagnosis, clinical myelopathy, and further cervical surgeries were associated with lower quality of life in the subgroup analyses of the patients. Similarly, in the EQ-VAS assessment, patient subgroups with spondylosis as a primary diagnosis, at least one reoperation, FDA device/drug status: Not applicable.

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The Finnish spine register (FinSpine): development, design, validation and utility

Marjamaa,

Huttunen,

Kankare

et al. 2023

Eur Spine J

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Purpose Our aim was to develop a nationwide, computer-based, Spine Register (FinSpine) for monitoring surgical activity, quality of surgery, long-term outcomes, and effectiveness of treatment. In this paper, we describe our experiences in the development and implementation of the register. Methods The register was developed by a steering group, consisting of orthopedic surgeons and neurosurgeons from the whole country. We strived to develop a register which would be in active use by spine surgeons and enable collection of Patient Reported Outcome and Experience Measures (PROMs and PREMs) automatically and prospectively. We are actively promoting the use of the register in order to gain a nationwide coverage and achieve high response-rates from both surgeons and patients. Results The use of FinSpine started in 2016 and it has been granted continuous funding from the Finnish Institute for Health and Welfare from the 1st of January 2023 onwards. Currently the register is used by 19/23 (83%) public hospitals and the use is expanding to private hospitals as well. The response-rate of surgeons is currently 80%. The response-rate of patients is on average 56% but reaches up to 90% in hospitals using register-coordinators. Conclusion The use of FinSpine is increasing. By gaining a larger coverage and completeness, the data can be used for research purposes which we believe will influence decision making and ultimately improve the outcomes and quality of life of the patients. Comparison with other national spine registers is possible, since FinSpine includes similar baseline characteristics and outcome measures (e.g., ODI, EQ-5D, VAS).

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Anterior cervical discectomy and fusion in young adults leads to favorable outcome in long-term follow-up

Cited by 16 publications

References 33 publications

Over-correction of Curvature in Surgical Segments Cause the Non-surgical Curvature Loss in One- and Two-level Anterior Cervical Discectomy and Fusion

Over-correction of Curvature in Surgical Segments Cause the Non-surgical Curvature Loss in One- and Two-level Anterior Cervical Discectomy and Fusion

Young adults undergoing ACDF surgery exhibit decreased health-related quality of life in the long term in comparison to the general population

The Finnish spine register (FinSpine): development, design, validation and utility

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