General Session: Cervical Degenerative
Presented by: M.F. Gornet - View Audio/Video Presentation (Members Only)
M.F. Gornet(1), A.G. Copay(2), F.W. Schranck(2)
(1) Orthopedic Center of St. Louis, St Louis, MO, United States
(2) SPIRITT Research, St Louis, MO, United States
Introduction: Cervical disc arthroplasty (CDA) is a proven, effective treatment for degenerative disc disease with radiculopathy and/or myelopathy. There is, however, little published evidence of the effectiveness of CDA to relieve pain and improve function in patients with a primary diagnosis of axial neck pain.
Purpose: To examine clinical and functional outcomes in patients undergoing CDA for predominant axial neck pain.
Methods: Analysis of patients at a single site who underwent CDA at one or more levels from C3-C7. Patients were divided into 2 groups for analysis on the basis of their primary diagnosis: predominant axial neck pain (AX), or radiculopathy and/or /myelopathy (RM). Clinical and functional measures including Neck Disability Index (NDI), numerical pain scales (0-20) for neck pain and arm pain, and return to work were collected preoperatively, at 12 and 24 months.
Results: Patients in the AX (n=59) and RM (n=94) groups were similar with respect to all demographic characteristics (including gender, age, BMI, smoking status, education, employment, and co-morbidities). Patients in the RM group had less multi-level surgery than the AX group: 23.4% vs. 59.9% (p=0.002). Patients in the RM group had significantly higher mean arm pain score (12.62 ± 5.11) than the AX group (10.29 ± 5.80) prior to surgery (p=0.010); neck pain, NDI, PCS and MCS scores were not significantly different between the 2 groups. Operative time, blood loss, secondary surgeries, and surgery-related AEs were similar for both groups. Both RM and AX patients had statistically significant improvement from baseline to 1 year and 2 years post-op for NDI, neck pain, arm pain, PCS, and MCS scores. All postoperative outcomes scores were not significantly different between the 2 groups. The amount of improvement in arm pain at 1 year was significantly greater for RM (7.25 ± 5.95) than AX patients (4.68 ± 6.77) (p=0.015). At 2 years, arm pain improvement was similar in both groups (6.17 ± 6.09 vs. 5.12 ± 5.49, p=0.286). The change in all other scores was not different between the groups. At 1 year, RM and AX patients improved a mean 29.03 ± 22.29 vs. 25.47 ± 19.42 in NDI (p=0.294), 4.49 ± 3.08 vs. 3.66 ± 2.67 in neck pain (p= 0.750), 9.95 ± 10.82 vs. 9.09 ± 9.36 in PCS (p=0.604), and 7.66 ± 12.92 vs. 9.66 ± 12.08 in MCS (p=0.320). At 2 years, RM and AX patients improved a mean 25.74 ± 21.14 vs. 27.29 ± 17.46 in NDI (p=0.640), 6.60 ± 5.87 vs. 7.08 ± 4.71 in neck pain, 43.81 ± 11.75 vs. 42.77 ± 11.15 in PCS (p=0.632), and 46.05 ± 13.22 vs. 44.11 ± 12.94 in MCS (p=0.434). By 2 years, 80.5% of RM and 79.2% of AX patients had returned to work (p=0.513); average time to return to work was 117.64 ± 128.88 days for RM vs. 111.86 ± 69.64 days for AX patients (p=0.789).
Conclusions: Appropriately selected patients with predominant axial neck pain may achieve clinical and functional outcomes comparable to patients with a primary diagnosis of radiculopathy/myelopathy after CDA.