Cervical spine alignment and patient reported outcomes after multilevel ACDF using self-locking cages: a cohort study

Abstract

Background Cervical alignment and patient reported outcomes (PROs) interaction has not been completely described in anterior cervical discectomy and fusion (ACDF) with use of self-locking cages (SLCs).

Objective This study aimed to determine the relationship between PROs and radiographic alignment of patients with cervical degenerative disease who undergo ACDF using SLCs.

Methodology Participants were grouped according to the number of operated levels (one-, two-, or three-level ACDF). Clinical assessments before and after surgery using SF-36, neck and radicular arm pain, Neck Disability index (NDI), modified Japanese Orthopedic Association (mJOA), the mJOA recovery rate, and dysphagia. Preoperative and postoperative radiographs were obtained to assess disc height (DH), C2/7 Cobb angle (CL), fused segment lordosis, cervical sagittal vertical axis (cSVA), and bone fusion.

Results A total of 194 segments operated in ninety-five individuals, with 2-year follow-up. Overall significant improvement in CL, fused segment cobb angle, disc height, and 97.9% fusion rate at final follow-up. There was no significant difference in preoperative and postoperative cSVA. Between group differences, CL improvement was significant only in 3-level ACDF. The average recovery rate mJOA at 2-year follow-up was 51.7%. Neurologic impairment, pain, and PROs improve after ACDF using SLCs and found weak correlation between PROs and radiographic alignment.

Conclusions

Neurologic impairment, pain, and PROs improve after ACDF using SLCs. Change in CL was significant only in three-level ACDF. In this series radiographic sagittal alignment parameters reconstruction did not correlate with PROs at final follow-up, emphasizing the role of segment decompression and fusion in patients without regional deformity.