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Predictive factors for the outcome of anterior cervical decompression and fusion
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0002-6075-4432
Department of Orthopaedics, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden.
Department of Neuro-Orthopaedic Surgery, Ryhov Hospital, Jönköping, Sweden.
Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
2003 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 12, no 3, 274-280 p.Article in journal (Refereed) Published
Abstract [en]

In a prospective study, 103 patients were randomised to anterior cervical decompression and fusion (ACDF) with a cervical carbon-fibre intervertebral fusion cage or the Cloward procedure. Preoperative background variables, active range of neck motion, handgrip strength, radiological evaluation and subjective variables were used in a multiple regression model to find the strongest predictors of postoperative outcome as measured by current pain intensity and the Neck Disability Index (NDI). Male sex, greater kyphosis at the level operated on, non-smoking, a greater neck mobility in right rotation, low disability on NDI, and older age were predictors of pain reduction and explained 30% of current pain intensity at follow-up. Higher educational level, non-smoking, greater kyphosis at the level operated on, a greater flexion mobility, greater right handgrip strength and lower current pain intensity were predictors of improvement, and explained 28% of the postoperative outcome on NDI. The most important predictor for postoperative pain intensity was the magnitude of the preoperative kyphosis. Preoperative pain intensity was the most important predictor for improved NDI. At follow-up about 70% of the patients still had deficit based on current pain intensity and NDI, and 44% had remaining dysfunction based on Odom's criteria. In conclusion, the multivariate analysis shows that male sex, non-smoking, greater segmental kyphosis and a low pain and disability level are preoperative predictors of a good outcome in ACDF. In addition, the study suggests the importance of other predictive variables than those studied for the outcome of ACDF.

Place, publisher, year, edition, pages
2003. Vol. 12, no 3, 274-280 p.
Keyword [en]
cervical spine, intervertebral fusion, prognostic factors, outcome
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-47773DOI: 10.1007/s00586-003-0530-2OAI: oai:DiVA.org:liu-47773DiVA: diva2:268669
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Functional analysis of the cervical spine: Reliability, reference data and outcome after anterior cervical decompression and fusion
Open this publication in new window or tab >>Functional analysis of the cervical spine: Reliability, reference data and outcome after anterior cervical decompression and fusion
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the thesis was to investigate the reliability of the test procedure, and to obtain reference values for active range of motion (AROM) of the neck, neck-, and hand strength. Another aim was to perform a broad assessment of outcome in patients with cervical disc disease operated on by anterior cervical decompression and fusion (ACDF) and to identify predictive factors for a good outcome. For a broad assessment it is important to have reliable objective and subjective variables, and reference values obtained in healthy people.

Three studies concern reliability and reference values for neck AROM, neck strength, and hand strength of healthy individuals. One study concerns the outcome of 34 consecutively included patients six months and one year after ACDF, and any remaining deficits afterwards. One study is a prospective randomised study of 103 patients concerning prognostic factors (mean follow-up 19 months, SD 6, range 12-24 months) for a good outcome of ACDF, and any remaining deficits afterwards.

The intra-, and inter-tester reliability of neck AROM, neck strength, and hand strength obtained from 30-32 healthy volunteers were considered substantial to almost perfect (ICC-values 0.61-0.98) and can be used for comparisons between or within groups. The reference values obtained in 101 asymptomatic men and women aged 25-64 years showed that age was the most important factor to take into consideration when measuring neck AROM, and gender was most important for neck and hand strength measurements. The patients showed benefits from ACDF at the one-year follow-up in neck strength in lateral flexion, neck muscle endurance in flexion, pain, numbness, ADL, Neck Disability Index (NDI), sick leave, change in general health, and symptom satisfaction. Except for a deterioration in general health there were no significant differences between the six-month and the one-year followup. The most important predictor for low postoperative pain intensity was greater preoperative kyphosis.

The predictive value of segmental kyphosis is noteworthy and of potential clinical interest. Low preoperative pain intensity was the most important predictor for improved NDI. Non-smoking males with a greater segmental kyphosis at the level of surgical intervention, with less severe pain experience and better initial function, had the best prognosis for a successful outcome of ACDF. Although the patients experienced benefits from surgery in many of the variables, a large number still had remaining deficits. These studies support the need for improvements in the selection for and the treatment techniques in both surgery and physiotherapy in degenerative cervical disorders.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2002. 84 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 738
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-26343 (URN)10867 (Local ID)91-7373-182-X (ISBN)10867 (Archive number)10867 (OAI)
Public defence
2002-09-06, Berzeliussalen, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-09-03Bibliographically approved

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Peolsson, AnneliVavruch, LudekÖberg, Birgitta

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