J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 10, Number 3, March 2018, pages 268-276

Correlation of Clinical and Radiological Outcome After Anterior Cervical Discectomy and Fusion With a Polyetheretherketone Cage

Figure 1. Line graphs illustrating: (a) the pain NRS mean scores and (b) the NDI mean scores preoperatively and then at 6- and 12-month time points. There was significant difference between time points for both instruments.

Figure 2. Line graphs illustrating C2-C7 ROM for the single- and two-level ACDF groups preoperatively and then at 6- and 12-month time points. There was significant difference between time points for both conditions.

**Table 1.** Evaluation Plan
Evaluation method	Preoperative	Postoperative (day of hospital discharge)	6-month follow-up	12-month follow-up
Lateral radiographs in neutral position	√	√	√	√
Full flexion/extension lateral radiographs	√		√	√
Cervical lordosis estimation (Cobb angle)	√	√	√	√
Cervical ROM calculation	√		√	√
NRS	√	√	√	√
NDI	√		√	√

Table 1. Evaluation Plan

Evaluation method

Preoperative

Postoperative (day of hospital discharge)

6-month follow-up

12-month follow-up

Lateral radiographs in neutral position

√

Full flexion/extension lateral radiographs

√

Cervical lordosis estimation (Cobb angle)

√

Cervical ROM calculation

√

NRS

√

NDI

√

**Table 2.** Summary of Inclusion and Exclusion Criteria
Inclusion criteria
Adult patients (age ≥ 18)
Symptomatic single- or two-level disc disease between C3 and C7/neck or arm pain (radicular) and/or a functional/neurological deficit/at least one of the following conditions confirmed by CT or MRI: herniated nucleus pulposus, spondylosis, and/or loss of disc height
Mentally, psychologically, and physically able to comply this protocol, including adherence to follow-up schedules and requirements, and filling out of necessary paperwork
Conservative treatment failed for at least 3 months (for only pain-related pathology)
Exclusion criteria
Previous cervical operations/cervical spine tumors/infections of the cervical spine/cervical injuries
Mental abnormalities

Table 2. Summary of Inclusion and Exclusion Criteria

Inclusion criteria

Adult patients (age ≥ 18)

Symptomatic single- or two-level disc disease between C3 and C7/neck or arm pain (radicular) and/or a functional/neurological deficit/at least one of the following conditions confirmed by CT or MRI: herniated nucleus pulposus, spondylosis, and/or loss of disc height

Mentally, psychologically, and physically able to comply this protocol, including adherence to follow-up schedules and requirements, and filling out of necessary paperwork

Conservative treatment failed for at least 3 months (for only pain-related pathology)

Exclusion criteria

Previous cervical operations/cervical spine tumors/infections of the cervical spine/cervical injuries

Mental abnormalities

**Table 3.** Summary of Patients’ Demographic Characteristics, and Surgical Data
Characteristic	No. of patients/value (%)
No. of patients	74
Male/female ratio	36:38
Age (years)
Mean	50.09 ± 13.54
Range	28 - 86
Body mass index (BMI)
Mean	27.82 ± 4.73
Range	20.3 - 42.0
No. of smokers	37 (50)
Radiculopathy/myelopathy ratio	36:38
Single-level ACDF	66 (89.19)
Two-level ACDF	8 (10.81)
ACDF (disc level)
C3-4	14 (17.07)
C4-5	16 (19.51)
C5-6	38 (46.34)
C6-7	14 (17.07)
Duration of postoperative brace (days)
Mean	34.44 ± 17.56
Range	30 - 120

Table 3. Summary of Patients’ Demographic Characteristics, and Surgical Data

Characteristic

No. of patients/value (%)

No. of patients

Male/female ratio

36:38

Age (years)

Mean

50.09 ± 13.54

Range

28 - 86

Body mass index (BMI)

Mean

27.82 ± 4.73

Range

20.3 - 42.0

No. of smokers

37 (50)

Radiculopathy/myelopathy ratio

36:38

Single-level ACDF

66 (89.19)

Two-level ACDF

8 (10.81)

ACDF (disc level)

C3-4

14 (17.07)

C4-5

16 (19.51)

C5-6

38 (46.34)

C6-7

14 (17.07)

Duration of postoperative brace (days)

Mean

34.44 ± 17.56

Range

30 - 120

**Table 4.** Outcomes of Clinical Parameters for Subgroups (Mean ± SD) and the Significance of the Differences Between Subgroups
Subgroups	NRS	NDI
M indicates months. NDI (%).
Smokers (n = 37)	6.32 ± 2.86	2.38 ± 1.74	0.79 ± 1.52	0.19 ± 0.74	23.89 ± 12.54	2.35 ± 3.12	0.57 ± 1.72
Non-smokers (n = 37)	6.00 ± 2.59	2.41 ± 1.54	0.62 ± 1.14	0.16 ± 0.73	24.08 ± 16.35	4.54 ± 6.18	1.97 ± 5.66
P value	0.611	0.944	0.582	0.874	0.956	0.058	0.156
Myelopathy (n = 38)	5.79 ± 2.91	2.16 ± 1.42	0.51 ± 1.03	0.03 ± 0.16	23.32 ± 15.82	3.76 ± 6.13	1.63 ± 5.27
Radiculopathy (n = 36)	6.57 ± 2.50	2.71 ± 1.77	0.94 ± 1.61	0.34 ± 1.03	24.46 ± 13.19	3.20 ± 3.44	0.91 ± 2.77
P value	0.225	0.143	0.181	0.080	0.740	0.634	0.475
Single-level fusion (n = 66)	6.33 ± 2.75	2.44 ± 1.67	0.79 ± 1.39	0.20 ± 0.77	23.29 ± 14.27	3.38 ± 4.47	1.12 ± 3.79
Two-level fusion (n = 8)	4.75 ± 2.05	2.00 ± 1.19	0.00 ± 0.00	0.00 ± 0.00	29.75 ± 15.80	4.00 ± 8.55	2.50 ± 7.07
P value	0.120	0.475	0.095	0.474	0.235	0.845	0.386

Table 4. Outcomes of Clinical Parameters for Subgroups (Mean ± SD) and the Significance of the Differences Between Subgroups

Subgroups

NRS

NDI

Preoperative

Postoperative

6 M

12 M

Preoperative

6 M

12 M

M indicates months. NDI (%).

Smokers (n = 37)

6.32 ± 2.86

2.38 ± 1.74

0.79 ± 1.52

0.19 ± 0.74

23.89 ± 12.54

2.35 ± 3.12

0.57 ± 1.72

Non-smokers (n = 37)

6.00 ± 2.59

2.41 ± 1.54

0.62 ± 1.14

0.16 ± 0.73

24.08 ± 16.35

4.54 ± 6.18

1.97 ± 5.66

P value

0.611

0.944

0.582

0.874

0.956

0.058

0.156

Myelopathy (n = 38)

5.79 ± 2.91

2.16 ± 1.42

0.51 ± 1.03

0.03 ± 0.16

23.32 ± 15.82

3.76 ± 6.13

1.63 ± 5.27

Radiculopathy (n = 36)

6.57 ± 2.50

2.71 ± 1.77

0.94 ± 1.61

0.34 ± 1.03

24.46 ± 13.19

3.20 ± 3.44

0.91 ± 2.77

P value

0.225

0.143

0.181

0.080

0.740

0.634

0.475

Single-level fusion (n = 66)

6.33 ± 2.75

2.44 ± 1.67

0.79 ± 1.39

0.20 ± 0.77

23.29 ± 14.27

3.38 ± 4.47

1.12 ± 3.79

Two-level fusion (n = 8)

4.75 ± 2.05

2.00 ± 1.19

0.00 ± 0.00

29.75 ± 15.80

4.00 ± 8.55

2.50 ± 7.07

P value

0.120

0.475

0.095

0.474

0.235

0.845

0.386

**Table 5.** Outcomes of Clinical and Radiological Parameters for the Sample as a Whole (Mean ± SD)
Outcome	Preoperative	Postoperative	6 M	12 M
M indicates months. NDI (%). Cobb angle and ROM (°). Min-max in brackets.
NRS (n = 74)	6.16 ± 2.7 (0 - 10)	2.40 ± 1.62 (0 - 6)	0.70 ± 1.33 (0 - 6)	0.17 ± 0.72 (0 - 4)
NDI (n = 74)	23.88 ± 14.4 (0 - 74)		3.40 ± 4.96 (0 - 25)	1.25 ± 4.29 (0 - 25)
Cobb angle (n = 74)	14.7 ± 9.36 (-22.0 - 42.0)	14.88 ± 8.36 (2.0 - 43.0)	12.0 ± 9.56 (-9.0 - 46.0)	11.96 ± 9.55 (-9.0 - 46.0)
ROM (n = 74)	50.8 ± 12.59 (15.0 - 68.0)		41.25 ± 12.24 (12.0 - 63.5)	41.22 ± 11.82 (12.0 - 60.0)

Table 5. Outcomes of Clinical and Radiological Parameters for the Sample as a Whole (Mean ± SD)

Outcome

Preoperative

Postoperative

6 M

12 M

M indicates months. NDI (%). Cobb angle and ROM (°). Min-max in brackets.

NRS (n = 74)

6.16 ± 2.7 (0 - 10)

2.40 ± 1.62 (0 - 6)

0.70 ± 1.33 (0 - 6)

0.17 ± 0.72 (0 - 4)

NDI (n = 74)

23.88 ± 14.4 (0 - 74)

3.40 ± 4.96 (0 - 25)

1.25 ± 4.29 (0 - 25)

Cobb angle (n = 74)

14.7 ± 9.36 (-22.0 - 42.0)

14.88 ± 8.36 (2.0 - 43.0)

12.0 ± 9.56 (-9.0 - 46.0)

11.96 ± 9.55 (-9.0 - 46.0)

ROM (n = 74)

50.8 ± 12.59 (15.0 - 68.0)

41.25 ± 12.24 (12.0 - 63.5)

41.22 ± 11.82 (12.0 - 60.0)

**Table 6.** Outcomes of Radiological Parameters for Subgroups (Mean ± SD) and the Significance of the Differences Between Subgroups
Subgroups	Cobb angle	ROM
M indicates months. Cobb angle and ROM (°).
Smokers (n = 37)	14.95 ± 11.26	16.40 ± 8.74	11.40 ± 10.33	11.39 ± 10.29	51.45 ± 11.04	42.54 ± 10.91	42.80 ± 10.42
Non-smokers (n = 37)	13.93 ± 6.50	12.70 ± 6.71	12.01 ± 8.24	11.93 ± 8.22	48.50 ± 14.06	40.00 ± 13.45	39.68 ± 13.01
P value	0.637	0.085	0.780	0.804	0.320	0.386	0.269
Myelopathy (n = 38)	16.80 ± 7.89	15.55 ± 8.72	12.62 ± 8.61	12.58 ± 8.60	52.37 ± 10.93	42.26 ± 12.20	42.19 ± 11.32
Radiculopathy (n = 36)	11.71 ± 9.85	13.33 ± 7.06	10.60 ± 10.09	10.54 ± 10.03	47.00 ± 13.87	39.74 ± 12.13	39.74 ± 12.13
P value	0.079	0.238	0.360	0.354	0.069	0.390	0.387
Single-level fusion (n = 66)	13.86 ± 9.10	14.39 ± 7.36	11.26 ± 8.70	11.21 ± 8.65	49.88 ± 12.68	41.62 ± 12.49	41.50 ± 12.06
Two-level fusion (n = 8)	19.19 ± 8.62	15.87 ± 12.45	15.44 ± 13.35	15.37 ± 13.41	50.69 ± 13.14	37.93 ± 9.79	38.64 ± 9.79
P value	0.121	0.622	0.232	0.232	0.867	0.453	0.548

Table 6. Outcomes of Radiological Parameters for Subgroups (Mean ± SD) and the Significance of the Differences Between Subgroups

Subgroups

Cobb angle

ROM

Preoperative

Postoperative

6 M

12 M

Preoperative

6 M

12 M

M indicates months. Cobb angle and ROM (°).

Smokers (n = 37)

14.95 ± 11.26

16.40 ± 8.74

11.40 ± 10.33

11.39 ± 10.29

51.45 ± 11.04

42.54 ± 10.91

42.80 ± 10.42

Non-smokers (n = 37)

13.93 ± 6.50

12.70 ± 6.71

12.01 ± 8.24

11.93 ± 8.22

48.50 ± 14.06

40.00 ± 13.45

39.68 ± 13.01

P value

0.637

0.085

0.780

0.804

0.320

0.386

0.269

Myelopathy (n = 38)

16.80 ± 7.89

15.55 ± 8.72

12.62 ± 8.61

12.58 ± 8.60

52.37 ± 10.93

42.26 ± 12.20

42.19 ± 11.32

Radiculopathy (n = 36)

11.71 ± 9.85

13.33 ± 7.06

10.60 ± 10.09

10.54 ± 10.03

47.00 ± 13.87

39.74 ± 12.13

P value

0.079

0.238

0.360

0.354

0.069

0.390

0.387

Single-level fusion (n = 66)

13.86 ± 9.10

14.39 ± 7.36

11.26 ± 8.70

11.21 ± 8.65

49.88 ± 12.68

41.62 ± 12.49

41.50 ± 12.06

Two-level fusion (n = 8)

19.19 ± 8.62

15.87 ± 12.45

15.44 ± 13.35

15.37 ± 13.41

50.69 ± 13.14

37.93 ± 9.79

38.64 ± 9.79

P value

0.121

0.622

0.232

0.867

0.453

0.548