The Outcomes of Patients with Neck Pain following ACDF: A Comparison of Patients with Radiculopathy, Myelopathy, or Mixed Symptomatology.

STUDY DESIGN Retrospective cohort study. OBJECTIVE The goal of the present study was to determine whether neck pain responds differently to anterior cervical discectomy and fusion (ACDF) between patients with cervical radiculopathy and/or cervical myelopathy. SUMMARY OF BACKGROUND DATA Many patients who undergo ACDF because of radiculopathy / myelopathy also complain of neck pain. However, no studies have compared the response of significant neck pain to ACDF METHODS.: Patients undergoing 1-3 level primary ACDF for radiculopathy and/or myelopathy with significant (VAS ≥ 3) neck pain and a minimum of 1-year follow-up were included. Based on preoperative symptoms patients were split into groups for analysis: radiculopathy (R group), myelopathy (M group), or both (MR group). Groups were compared for differences in HRQOL outcomes: PCS-12, MCS-12, NDI, VAS Neck, and VAS Arm pain. RESULTS 235 patients met inclusion criteria. There were 117 patients in the R group, 53 in the M group, and 65 in the MR group. Preoperative VAS Neck pain was found to be significantly higher in the R group versus M group (6.5 vs 5.5; p = 0.046). Postoperatively, all cohorts experienced significant (p < 0.001) reduction in VAS Neck pain, (ΔVAS neck; R group: -2.9, M: -2.5, MR: -2.5) with no significant differences between groups. However, myelopathic patients showed greater improvement in absolute MCS-12 scores (p = 0.011), RR (p = 0.006), and % MCID (p = 0.013) when compared with radiculopathy patients. This greater improvement remained following regression analysis (p = 0.025). CONCLUSION Patients with substantial preoperative neck pain experienced significant reduction in their neck pain, disability and physical function following ACDF, whether treated for radiculopathy or myelopathy. However, in this study, only myelopathy patients had significant improvements in their mental function as represented by MCS improvements. LEVEL OF EVIDENCE 3.

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