How Does the Severity of Neuroforaminal Compression in Cervical Radiculopathy Affect Outcomes of Anterior Cervical Discectomy and Fusion
Study Design This study is a retrospective cohort study. Purpose This study aims to determine whether preoperative neuroforaminal stenosis (FS) severity is associated with motor function patient-reported outcome measures (PROMs) following anterior cervical discectomy and fusion (ACDF). Overview of L...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Korean Spine Society
2023-12-01
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| Series: | Asian Spine Journal |
| Subjects: | |
| Online Access: | http://asianspinejournal.org/upload/pdf/asj-2023-0066.pdf |
| _version_ | 1827394066580504576 |
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| author | Mark J. Lambrechts Tariq Z. Issa Yunsoo Lee Khoa S. Tran Jeremy Heard Caroline Purtill Tristan B. Fried Samuel Oh Erin Kim John J. Mangan Jose A. Canseco I. David Kaye Jeffrey A. Rihn Alan S. Hilibrand Alexander R. Vaccaro Christopher K. Kepler Gregory D. Schroeder |
| author_facet | Mark J. Lambrechts Tariq Z. Issa Yunsoo Lee Khoa S. Tran Jeremy Heard Caroline Purtill Tristan B. Fried Samuel Oh Erin Kim John J. Mangan Jose A. Canseco I. David Kaye Jeffrey A. Rihn Alan S. Hilibrand Alexander R. Vaccaro Christopher K. Kepler Gregory D. Schroeder |
| author_sort | Mark J. Lambrechts |
| collection | DOAJ |
| description | Study Design This study is a retrospective cohort study. Purpose This study aims to determine whether preoperative neuroforaminal stenosis (FS) severity is associated with motor function patient-reported outcome measures (PROMs) following anterior cervical discectomy and fusion (ACDF). Overview of Literature Cervical FS can significantly contribute to patient symptoms. While magnetic resonance imaging (MRI) has been used to classify FS, there has been limited research into the impact of FS severity on patient outcomes. Methods Patients undergoing primary, elective 1–3 level ACDF for radiculopathy at a single academic center between 2015 and 2021 were identified retrospectively. Cervical FS was evaluated using axial T2-weighted MRI images via a validated grading scale. The maximum degree of stenosis was used for multilevel disease. Motor symptoms were classified using encounters at their final preoperative and first postoperative visits, with examinations ≤3/5 indicating weakness. PROMs were obtained preoperatively and at 1-year follow-up. Bivariate analysis was used to compare outcomes based on stenosis severity, followed by multivariable analysis. Results This study included 354 patients, 157 with moderate stenosis and 197 with severe stenosis. Overall, 58 patients (16.4%) presented with upper extremity weakness ≤3/5. A similar number of patients in both groups presented with baseline motor weakness (13.5% vs. 16.55, p=0.431). Postoperatively, 97.1% and 87.0% of patients with severe and moderate FS, respectively, experienced full motor recovery (p=0.134). At 1-year, patients with severe neuroforaminal stenosis presented with significantly worse 12-item Short Form Survey Physical Component Score (PCS-12) (33.3 vs. 37.3, p=0.049) but demonstrated a greater magnitude of improvement (ΔPCS-12: 5.43 vs. 0.87, p=0.048). Worse stenosis was independently associated with greater ΔPCS-12 at 1-year (β=5.59, p=0.022). Conclusions Patients with severe FS presented with worse preoperative physical health. While ACDF improved outcomes and conferred similar motor recovery in all patients, those with severe FS reported much better improvement in physical function. |
| first_indexed | 2024-03-08T18:01:50Z |
| format | Article |
| id | doaj.art-dcd0792d1b3c406b8b6b37c2f20acc78 |
| institution | Directory Open Access Journal |
| issn | 1976-1902 1976-7846 |
| language | English |
| last_indexed | 2024-03-08T18:01:50Z |
| publishDate | 2023-12-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj.art-dcd0792d1b3c406b8b6b37c2f20acc782024-01-02T01:14:20ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462023-12-011761051105810.31616/asj.2023.00661568How Does the Severity of Neuroforaminal Compression in Cervical Radiculopathy Affect Outcomes of Anterior Cervical Discectomy and FusionMark J. Lambrechts0Tariq Z. Issa1Yunsoo Lee2Khoa S. Tran3Jeremy Heard4Caroline Purtill5Tristan B. Fried6Samuel Oh7Erin Kim8John J. Mangan9Jose A. Canseco10I. David Kaye11Jeffrey A. Rihn12Alan S. Hilibrand13Alexander R. Vaccaro14Christopher K. Kepler15Gregory D. Schroeder16 Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Icahn School of Medicine at Mount Sinai, New York, NY, USA Boston University School of Medicine, Boston University, Boston, MA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USAStudy Design This study is a retrospective cohort study. Purpose This study aims to determine whether preoperative neuroforaminal stenosis (FS) severity is associated with motor function patient-reported outcome measures (PROMs) following anterior cervical discectomy and fusion (ACDF). Overview of Literature Cervical FS can significantly contribute to patient symptoms. While magnetic resonance imaging (MRI) has been used to classify FS, there has been limited research into the impact of FS severity on patient outcomes. Methods Patients undergoing primary, elective 1–3 level ACDF for radiculopathy at a single academic center between 2015 and 2021 were identified retrospectively. Cervical FS was evaluated using axial T2-weighted MRI images via a validated grading scale. The maximum degree of stenosis was used for multilevel disease. Motor symptoms were classified using encounters at their final preoperative and first postoperative visits, with examinations ≤3/5 indicating weakness. PROMs were obtained preoperatively and at 1-year follow-up. Bivariate analysis was used to compare outcomes based on stenosis severity, followed by multivariable analysis. Results This study included 354 patients, 157 with moderate stenosis and 197 with severe stenosis. Overall, 58 patients (16.4%) presented with upper extremity weakness ≤3/5. A similar number of patients in both groups presented with baseline motor weakness (13.5% vs. 16.55, p=0.431). Postoperatively, 97.1% and 87.0% of patients with severe and moderate FS, respectively, experienced full motor recovery (p=0.134). At 1-year, patients with severe neuroforaminal stenosis presented with significantly worse 12-item Short Form Survey Physical Component Score (PCS-12) (33.3 vs. 37.3, p=0.049) but demonstrated a greater magnitude of improvement (ΔPCS-12: 5.43 vs. 0.87, p=0.048). Worse stenosis was independently associated with greater ΔPCS-12 at 1-year (β=5.59, p=0.022). Conclusions Patients with severe FS presented with worse preoperative physical health. While ACDF improved outcomes and conferred similar motor recovery in all patients, those with severe FS reported much better improvement in physical function.http://asianspinejournal.org/upload/pdf/asj-2023-0066.pdfanterior cervical discectomy and fusioncervical spinemotor functionneuroforaminal stenosisradiculopathy |
| spellingShingle | Mark J. Lambrechts Tariq Z. Issa Yunsoo Lee Khoa S. Tran Jeremy Heard Caroline Purtill Tristan B. Fried Samuel Oh Erin Kim John J. Mangan Jose A. Canseco I. David Kaye Jeffrey A. Rihn Alan S. Hilibrand Alexander R. Vaccaro Christopher K. Kepler Gregory D. Schroeder How Does the Severity of Neuroforaminal Compression in Cervical Radiculopathy Affect Outcomes of Anterior Cervical Discectomy and Fusion Asian Spine Journal anterior cervical discectomy and fusion cervical spine motor function neuroforaminal stenosis radiculopathy |
| title | How Does the Severity of Neuroforaminal Compression in Cervical Radiculopathy Affect Outcomes of Anterior Cervical Discectomy and Fusion |
| title_full | How Does the Severity of Neuroforaminal Compression in Cervical Radiculopathy Affect Outcomes of Anterior Cervical Discectomy and Fusion |
| title_fullStr | How Does the Severity of Neuroforaminal Compression in Cervical Radiculopathy Affect Outcomes of Anterior Cervical Discectomy and Fusion |
| title_full_unstemmed | How Does the Severity of Neuroforaminal Compression in Cervical Radiculopathy Affect Outcomes of Anterior Cervical Discectomy and Fusion |
| title_short | How Does the Severity of Neuroforaminal Compression in Cervical Radiculopathy Affect Outcomes of Anterior Cervical Discectomy and Fusion |
| title_sort | how does the severity of neuroforaminal compression in cervical radiculopathy affect outcomes of anterior cervical discectomy and fusion |
| topic | anterior cervical discectomy and fusion cervical spine motor function neuroforaminal stenosis radiculopathy |
| url | http://asianspinejournal.org/upload/pdf/asj-2023-0066.pdf |
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