Outcomes of cervical disc replacement in patients with neck pain greater than arm pain |
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| Institution: | 1. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA;2. Weill Cornell Medical College, New York, NY, USA;1. Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General Hospital, Harvard Medical School, Yawkey 3A, 55 Fruit St, Boston, MA, 02114, USA;2. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit St, Boston, MA, 02114, USA;1. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;2. Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;3. Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA;1. School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;2. Division of Endocrinology and Metabolism, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan;3. Department of Orthopedics, Taipei Medical University Hospital, No.252, Wu-hsing St., Taipei 11031, Taiwan;4. Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;5. International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;1. Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;2. Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;3. Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;4. Fraunhofer Institute for Laser Technology ILT, Aachen, Germany;5. Helmholtz Zentrum München, German Research Center for Environmental Health, Individual Monitoring Service, Munich, Germany;6. Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;1. Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China;2. Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China;3. Department of Orthopaedics and Traumatology, SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China;4. Department of Orthopaedics and Traumatology, Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China;5. The Joint Scoliosis Research Center of the Chinese University of Hong Kong–Nanjing University, Faculty of Medicine, The Chinese University of Hong Kong Hong Kong, China;1. Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand;2. Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand;3. Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;4. The Kirby Institute, University of New South Wales, Sydney, Australia;5. Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand |
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| Abstract: | BACKGROUND CONTEXTAlthough anterior cervical discectomy and fusion is believed to positively impact a patient's radicular symptoms as well as axial neck pain, the outcomes of cervical disc replacement (CDR) with regards to neck pain specifically have not been established.PURPOSEPrimary: to assess clinical improvement following CDR in patients with neck pain greater than arm pain. Secondary: to compare the clinical outcomes between patients undergoing CDR for predominant neck pain (pNP), predominant arm pain (pAP), and equal neck and arm pain (ENAP).STUDY DESIGNRetrospective review of prospectively collected data.PATIENT SAMPLEPatients who had undergone one- or two-level CDR for the treatment of degenerative cervical pathology and had a minimum of 6-month follow-up were included and stratified into three cohorts based on their predominant location of pain: pNP, pAP, and ENAP.OUTCOME MEASURESPatient-reported outcomes: Neck Disability Index (NDI), Visual Analog Scale (VAS) neck and arm, Short Form 12-Item Physical Health Score (SF12-PHS), Short Form 12-Item Mental Health Score (SF12-MHS), minimal clinically important difference (MCID).METHODSChanges in Patient-reported outcomes from preoperative values to early (<6 months) and late (≥6 months) postoperative timepoints were analyzed within each of the three groups. The percentage of patients achieving MCID was also evaluated.RESULTSOne hundred twenty-five patients (52 pNP, 30 pAP, 43 ENAP) were included. The pNP cohort demonstrated significant improvements in early and late NDI and VAS-Neck, early SF-12 MCS, and late SF-12 PCS. The pAP and ENAP cohorts demonstrated significant improvements in all PROMs, including NDI, VAS-Neck, VAS-Arm, SF-12 PCS, and SF-12 MCS, at both the early and late timepoints. No statistically significant differences were found in the MCID achievement rates for NDI, VAS-Neck, SF-12 PCS, and SF-12 MCS at the late timepoint amongst the three groups.CONCLUSIONSCDR leads to comparable improvement in neck pain and disability in patients presenting with neck pain greater than arm pain and meeting specific clinical and radiographic criteria. |
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