The Impact of Single-Level Anterior Cervical Discectomy and Fusion on Cervical Sagittal Parameters and Its Correlation With Pain and Functional Outcome of Patients With Neck Pain

Mohsen Rostami; Navid Moghadam; Ibrahim Obeid; Morteza Faghih Jouibari; Mohammad Zarei; Mersad Moosavi; Alireza Khoshnevisan; Farzin Farahbakhsh; Fatemeh Moosaie; Saeid Ehteshami; Alireza Borghei; Milad Shafizadeh; Ramin Kordi; Masoud Khadivi

doi:10.14444/8115

The Impact of Single-Level Anterior Cervical Discectomy and Fusion on Cervical Sagittal Parameters and Its Correlation With Pain and Functional Outcome of Patients With Neck Pain

Int J Spine Surg. 2021 Oct;15(5):899-905. doi: 10.14444/8115. Epub 2021 Oct 8.

Authors

Mohsen Rostami^{1

2

3}, Navid Moghadam^{1

3}, Ibrahim Obeid⁴, Morteza Faghih Jouibari², Mohammad Zarei⁵, Mersad Moosavi³, Alireza Khoshnevisan², Farzin Farahbakhsh^{1

2}, Fatemeh Moosaie¹, Saeid Ehteshami⁶, Alireza Borghei⁷, Milad Shafizadeh², Ramin Kordi¹, Masoud Khadivi³

Affiliations

¹ Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
³ Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Bordeaux Cedex, France.
⁵ Department of Orthopedics, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
⁶ Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
⁷ Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.

PMID: 34625454
PMCID: PMC8651199
DOI: 10.14444/8115

Abstract

Background: This study examines the changes in segmental and global cervical sagittal parameters after single-level anterior cervical discectomy and fusion (ACDF) in patients with cervical radiculopathy or myelopathy. We also investigate whether these changes have any relation with postoperative pain and functional outcome of the patients.

Methods: Sixty patients (37 females and 23 males) with a mean age of 45.9 ± 9.5 years who were candidates of single-level ACDF due to cervical myelopathy or radiculopathy participated in the study. At baseline, 1 month, and 6 months after ACDF, outcomes of the study including sagittal balance parameters, pain intensity, and Neck Disability Index (NDI) were measured among the patients. Intensity of pain and neck disability were measured using the visual analog scale (VAS) and validated version of NDI, respectively. Using a standard lateral cervical radiography, the Cobb angle for occiput-C2, C1-C2, and C2-C7 as well as operation-level angle (OA; Cobb's angle at the level of discopathy), the thoracic inlet angle, and C7 and T1 slope angles were measured.

Results: The intensity of pain and neck disability of patients improved significantly during the follow up of the study comparing with baseline measurements (P < .001). There was a significant correlation between the increase of C2-C7 angle, C1-C2 angle, and OA and improvement in neck pain and NDI at 1- and 6-month follow ups.

Conclusions: We found that changes at C2-C7 angle, C1-C2 angle, and OA have positive significant correlation with clinical outcome including pain improvement and decrease of disability in patients who undergo ACDF.

Level of evidence: 3.

Clinical relevance: The results of this study might be beneficial in selection of cervical cages with appropriate size during ACDF surgery, as our findinds showed that larger cages could lead to better functional outcome in patients.

Keywords: Cervical Discectomy; Disability; Myelopathy; Sagittal balance; radiculopathy.