How Do Patients With Predominant Neck Pain Improve After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy?

Srikanth N Divi; Dhruv K C Goyal; Barrett I Woods; Kristen J Nicholson; Harold I Salmons; Matthew S Galetta; Mahir A Qureshi; Meghan E Lam; Andrew L DiMatteo; D Greg Anderson; Mark F Kurd; Jeffrey A Rihn; Ian D Kaye; Christopher K Kepler; Alan S Hilibrand; Alexander R Vaccaro; Kristen E Radcliff; Gregory D Schroeder

doi:10.14444/8212

How Do Patients With Predominant Neck Pain Improve After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy?

Int J Spine Surg. 2022 Apr;16(2):240-246. doi: 10.14444/8212. Epub 2022 Mar 10.

Authors

Srikanth N Divi¹, Dhruv K C Goyal², Barrett I Woods¹, Kristen J Nicholson¹, Harold I Salmons¹, Matthew S Galetta¹, Mahir A Qureshi¹, Meghan E Lam¹, Andrew L DiMatteo¹, D Greg Anderson¹, Mark F Kurd¹, Jeffrey A Rihn¹, Ian D Kaye¹, Christopher K Kepler¹, Alan S Hilibrand¹, Alexander R Vaccaro¹, Kristen E Radcliff¹, Gregory D Schroeder¹

Affiliations

¹ Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA.
² Department of Orthopaedic Surgery, Rothman Institute Thomas Jefferson University, Philadelphia, PA, USA dhruvkcgoyal@gmail.com.

PMID: 35273114
PMCID: PMC9930673
DOI: 10.14444/8212

Abstract

Background: The presence of predominant pain in the arm vs the neck as a predictor of postoperative outcomes after anterior cervical discectomy and fusion (ACDF) has been seldom reported; therefore, the purpose of this study was to determine whether patients with predominant neck pain improve after surgery compared to patients with predominant arm pain or those with mixed symptoms in patients undergoing ACDF for radiculopathy.

Methods: A retrospective cohort study was conducted on patients who underwent ACDF at a single center from 2016 to 2018. Patients were split into groups based on preoperative neck and arm pain scores: neck (N) pain dominant group (visual analog scale [VAS] neck ≥ VAS arm by 1.0 point); neutral group (VAS neck < VAS arm by 1.0 point); or arm (A) pain dominant group (VAS arm ≥ VAS neck by 1.0 point), using a threshold difference of 1.0 point. Subsequently, individuals were substratified into 2 groups based on the arm to neck pain ratio (ANR): non-arm pain dominant defined as ANR ≤1.0 and arm pain dominant (APD) defined as ANR >1.0. Patient-reported outcome measurements including Neck Disability Index (NDI), Physical Component Score-12, and Mental Component Score (MCS-12) were compared between groups.

Results: No significant differences between groups when stratifying patients using a threshold difference of 1.0 point. When stratifying patients using the ANR, those in the APD group had significantly higher postoperative MCS-12 (P = 0.008) and NDI (P = 0.011) scores. In addition, the APD group showed a greater magnitude of improvement for MCS-12 and NDI scores (P = 0.043 and P = 0.038, respectively). Multiple linear regression showed that the A and the APD groups were both independent predictors of improvement in NDI.

Conclusion: Patients with dominant arm pain showed significantly greater improvement in terms of MCS-12 and NDI scores compared to patients with dominant neck pain.

Clinical relevance: To compare the impact of ACDF on arm and neck pain in the context of cervical radiculopathy using patient-reported outcome measures as an objective measurement.

Keywords: ACDF; PROMs; VAS arm; VAS neck; radiculopathy.

This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2022 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.