Comorbidity Influence on Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

Abstract

This study aims to detail the association between comorbidity burden and achieving minimum clinically important difference (MCID) following anterior cervical discectomy and fusion (ACDF). Methods: A prospective surgical registry was retrospectively reviewed. Patients with missing preoperative Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) were excluded. Patients were stratified by Charlson Comorbidity Index (CCI): no comorbidities = 0 point; low CCI = 1-2 points; high CCI = ≥ 3 points. Demographic and perioperative characteristics were collected and evaluated for differences. Visual analogue scale (VAS), 12-item Short Form health survey (SF-12), and PROMIS PF were collected pre-and postoperatively and assessed for differences. Differences in achievement of MCID were compared using established values: VAS neck = 2.6, VAS arm = 4.1, NDI = 8.5, SF-12 physical composite score (SF-12 PCS) = 8.1, PROMIS PF = 4.5. Results: One hundred twenty-five ACDF patients were included: 37 had no comorbidities, 64 with low CCI, and 24 with high CCI. Higher CCI groups were older, nonsmokers, diabetic, arthritic, hypertensive, and had cancer. Multilevel fusions, operative time, length of stay, and later discharge day were associated with high CCI. VAS neck differed preoperatively by group. SF-12 PCS and PROMIS PF were inversely associated with CCI groups. CCI did not impact achievement of MCID for all outcomes. A lower rate of reaching MCID was demonstrated at 3 months for SF-12 PCS. Conclusion: Regardless of comorbidity burden, patients undergoing ACDF for cervical pathology demonstrated a similar rate of achieving MCID for VAS neck, VAS arm, NDI, and PROMIS PF. Regardless of CCI score, ACDF can have a significant benefit for patients.

Feeling better versus feeling good: interpreting pain relief using minimal clinically important differences and patient acceptable symptom states for patients who underwent lung cancer surgery

“…This study found that patients with higher CCI scores were more likely to achieve MCID, which is similar to the ndings of Elliot et al who concluded that due to the nature of the disease itself, more comorbidities affect the patient's perception of pain, and therefore patients with more comorbidities, i.e., higher CCI scores, have a reduced potential for pain improvement, and consequently, at long-term followup, perceived physical function improvement is poorer, leading to a reduction in patient-perceived bene t [25]. The patients who achieved PASS underwent single-port thoracoscopy and had no postoperative complications.…”

Comparing zero-profile and conventional cage and plate in anterior cervical discectomy and fusion using finite-element modeling

“…Cervical spondylosis is a major cause of spinal cord dysfunction 1 , 2 . If non-surgical treatment is unsuccessful, anterior cervical discectomy and fusion (ACDF) is considered the best surgical treatment 3 – 6 . During ACDF, a conventional cage and plate (CCP) implant is often used, which prevents interbody graft dislocation and improves sagittal alignment, interbody fusion rate, and stability 1 , 5 , 7 .…”