Study Design. Data were collected prospectively on 38 patients who underwent anterior cervical discectomy and fusion for neck pain with no symptoms or signs of radiculopathy or myelopathy.
Objectives. To determine the changes in pain and function after anterior cervical discectomy and fusion for nonradicular neck pain.
Summary of Background Data. There is considerable controversy regarding the role of anterior cervical discectomy and fusion for neck pain in the absence of radiculopathy or myelopathy. Although no studies have addressed this specific and common problem, it is known that anterior cervical discectomy and fusion for radiculopathy or myelopathy may also provide relief of neck pain for many patients.
Methods. Thirty-eight patients who underwent anterior cervical discectomy and fusion for neck pain were evaluated. Before and after surgery, the authors measured pain with a numerical rating scale, function with the Oswestry Disability Questionnaire, and final patient satisfaction. Final evaluation was done by a disinterested third party.
Results. All 38 patients were available for follow-up study. Mean age was 42.4 years, and mean duration of follow-up study was 53 months. All patients had painful disc(s) proven by discography. No patients had nerve root compression. Anterior cervical discectomy and fusion was performed at one level in 21 patients, two levels in 16 patients, and three levels in one patient. The mean score on the numerical rating scale for neck pain before surgery was 8.3 (range, 3-10) versus 4.1 (range, 0-10) after surgery. This difference is significant (P< 0.001). The mean score on the Oswestry Disability Questionnaire was 57.5 (range, 0-89) before surgery versus 38.9 (range, 0-80) after surgery. This difference is significant (P< 0.001). There were 30 (79%) patients who were satisfied with their outcome, and 8 (21%) who were not satisfied. There was no statistical difference in change of pain or function between patients with worker's compensation and those with other insurance or between men and women. Twenty patients were not working because of neck pain before surgery, and 15 were not working at the time of follow-up examination.
Conclusion. A significant decrease in pain, a significant increase in function, and a high degree of patient satisfaction were found with anterior cervical discectomy and fusion for neck pain. Improvements were not affectedby worker's compensation status or gender.
Chronic or frequently recurring neck pain affects almost one third of the adult population. 3 Fortunately, most patients respond to aggressive conservative care, which might include strength and body mechanics training, medications, and/or intraspinal injections. Despite excellent conservative care, however, there are patients who continue to have neck pain. Some are referred to pain management programs. Others are told that there is nothing left to do and that they must learn to live with it.
In the authors' clinical practice, it was noted that some patients who underwent anterior cervical discectomy and interbody fusion (ACDF) for cervical radiculopathy reported improvement in the axial component of their pain along with the improved radiculopathy. The efficacy of ACDF for cervical radiculopathy caused by disc herniation has been well established. 2,13,25,35,38 However, ACDF has not been used routinely for axial neck pain probably because of a paucity of literature rather than because of poor results. The authors began to perform ACDF for patients with predominantly axial pain and were impressed with the outcomes.
Patients with refractory neck pain require a detailed evaluation before consideration of surgery. To determine whether a disc is painful and possibly amenable to surgery, many spine centers rely on discography. However, the role of discography for the diagnosis of painful disc syndrome is itself controversial. In separate studies designed to assess the value of cervical discography to plan surgery, Whitecloud 43 and Siebenrock 32 reported 70% and 73% good to excellent results, respectively. Their patients underwent cervical fusion for nonradicular discogenic pain that had been identified by provocative discography. Their studies suggest that fusion is appropriate for the management for discogenic neck pain. Their results were descriptive and not quantified.
To evaluate the effectiveness of ACDF for axial neck pain, the authors reviewed their results with 38 consecutive patients who had undergone surgery by a single group of spine surgeons at a single institution. Each patient was re-evaluated by an independent third party to determine the change in pain, change in function, and patient satisfaction with outcome 2 or more years after ACDF.