Integrated outcome assessment after anterior cervical discectomy and fusion: myelocompression but not adjacent instability affect patient-reported quality of life and cervical spine symptoms.

Study Design. The authors conducted a cross-sectional study. Objective. Integrated assessment of adjacent instability (Al), myelocompression (MC), magnetic resonance imaging (MRI) signs of myelopathy (MRISM), physician-assessed clinical signs and symptoms, including clinical signs of myelopathy (CSM), patients self-reported symptoms and quality of life after anterior cervical discectomy and fusion (ACDF). Materials and Methods. Fifty-four patients who had ACDF between 1986 and 1995 received MRI scans, conventional and flexion/extension radiographs to assess myelocompression, MRISM, fusion, and Al. Clinical outcome was assessed using signs and symptoms based on selected items of Odom's criteria, Oswestry low back pain disability questionnaire, and the neck disab ility index. Patients reported their quality of the (QL) on a standardized instrument (Profiles of OL of Chronically III [PLC]) and by a specific validated Cervical Spine Symptom Scale (CSSS). Results. Myelocompression was found more frequently than erxpected (24%). MRISM were seen in 2 patients (4%). One of the 2 patients developed CSM. Fusion was achieved in 94% (with kyphosis in 17%). Al was found in 30%. However, only myelscompression but not Al was associated with statistically significant decreases in most OL scores (i.e., everyday capabilities, positive mood) and high cervical spine symptom burden (all P's < 0.05). Conclusions. The study results underline the need for a better understanding of the biomechanical changes in the adjecent unfused segments. Consensus is needed on postoperative follow-up guidelines, including pain management strategies. Future studies on the outcome of ACDF will profit from an integrated outcome approach, including assessments based on imaging, physicians, and patients.