#276 Restoration of Cervical Lordosis Is Associated with Improved Clinical Outcome in Anterior Cervical Discectomy and Fusion (ACDF) Patients

General Session: Cervical Motion Preservation

Presented by: I. Lieberman

Author(s):

I.H. Lieberman (1)
X. Hu (1)

(1) Texas Back Institute, Texas Health Presbyterian Hospital Plano, Scoliosis and Spine Tumor Center, Plano, TX, USA

Abstract

Introduction: Anterior cervical discectomy and fusion (ACDF) remains the standard of care for patients with cervical radiculopathy who are unresponsive to conservative medical care. Normal cervical lordosis (C2-C7) is measured at approximately 34 degrees. However, the maintenance/restoration of cervical lordosis is usually ignored as an outcome factor after ACDF surgeries.

Methods: Data were collected prospectively from 98 patients who underwent one or two level ACDF at a single institution. Cervical lordosis/kyphosis angles were measured preoperatively and at follow-up visits. The patients were classified into three different groups: Group 1, patients had cervical kyphosis or neutral cervical angle preoperatively and the angle was restored to lordosis postoperatively; Group 2, patients had cervical kyphosis or neutral cervical angle preoperatively and the angle was similar postoperatively; Group 3, patients had cervical lordosis preoperatively and the lordosis was maintained postoperatively. The visual analog scale (VAS) for neck pain, arm pain, and neck disability index (NDI) were obtained from each patient preoperatively and at the latest follow-up visit. ANOVA test was used to analyze if there is correlation between cervical lordosis maintenance/restoration and patients' clinical outcome.

Results: There were 21 patients in group 1 (median age: 46.7 years), 21 patients in group 2 (median age: 47.8 years) and 56 patients in group 3 (median age: 48.4 years). The patients' age and BMI were not significantly different among the three groups. On average at 18 months (range from 6 to 60 months) follow-up, the patients' neck VAS scores improved 4.48, 3.32, and 3.27 respectively in the three groups (p>0.05). The patients' arm VAS scores improved 3.88, 3.62, and 2.51 respectively in the three groups (p>0.05). The patients' NDI scores improved 26.74, 13.73 and 19.31 respectively in the three groups (p=0.02 between group 1 and group 2) (Figure 1 and 2).

Conclusions: The patients with restored cervical lordosis have better NDI score improvement. Our study suggests that restoration of cervical lordosis from kyphosis/neutral will contribute to improved clinical outcome in the patients who had one or two level ACDF surgeries.

Figure 1

Figure 2