Objective The clinical utility of anterior cervical plating for anterior cervical discectomy and fusion (ACDF) procedures remains controversial. This study aims to compare the impact of cervical plating on achievement of minimum clinically important difference (MCID) up to 2 years following ACDF.
Methods Patients undergoing primary, single-level ACDF procedures were grouped based on whether their procedure included application of an anterior cervical plate. Demographics, preoperative spinal diagnoses, operative characteristics, and patient-reported outcome measures (PROMs) were compared between plating groups. Achievement of an MCID was assessed using the following previously established thresholds: 12-item Short Form health survey physical component summary (SF-12 PCS) 8.1, visual analogue scale (VAS) neck 2.6, VAS arm 4.1, Neck Disability Index (NDI) 8.5. Rates of MCID achievement were compared between groups.
Results The cohort included 192 patients of whom 102 received plating and 90 received no plating. Plating status was significantly associated with Charlson Comorbidity Index and insurance status. Operative duration and estimated blood loss were significantly greater for the plating group. Both groups demonstrated significant improvements at the majority of postoperative timepoints. Significant intergroup differences in PROM improvement were demonstrated for VAS neck and NDI at 6 weeks. Rates of MCID achievement differed significantly between groups for NDI at 6 weeks, and 12 weeks, and SF-12 PCS overall.
Conclusion Patients improved significantly in terms of pain, disability and physical function, regardless of plating status, and with the exception of early neck pain and disability, these improvements were similar between groups. Patients that underwent plating as part of their ACDF procedure achieved an MCID for physical function at lower rates overall.
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The impact of operative level on reoperation rates and short-term patient-reported outcomes in 3-level anterior cervical discectomy and fusion Yulia Lee, Chloe Herczeg, Mitchell K. Ng, Jonathan Dalton, Rachel Huang, Joydeep Baidya, Jarod Olson, Robert J. Oris, Rajkishen Narayanan, William Green, Gregorio Baek, Joshua Mathew, Ian Argento, Natalie Lowenstein, Theresa Chua, Nicholas Wang, Alec Giak European Spine Journal.2026;[Epub] CrossRef
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Does the Presence of Preoperative Myelomalacia Impact Outcomes Following ACDF? Robert J. Oris, Jonathan Dalton, Ryan Lin, Rachel Huang, Jarod Olson, Chloe Herczeg, Joydeep Baidya, Rajkishen Narayanan, Evgeniy V. Uvarov, Keyur Patel, Harshill Patel, Theresa Chua, Thomas D. Cha, Mark F. Kurd, Ian David Kaye, Jose A. Canseco, Alan S. H Spine.2025; 50(22): 1539. CrossRef
Assessing Surgical Outcomes for Cage Plate System versus Stand-Alone Cage in Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis Elias Elias, Ali Daoud, Justin Smith, Charbel Elias, Zeina Nasser World Neurosurgery.2024; 185: 150. CrossRef
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Objective To assess change in Patient-Reported Outcome Measures (PROM) as predictors for revision lumbar decompression (LD).
Methods Patients who underwent primary, single or multilevel LD were retrospectively reviewed. Patients were categorized according to whether or not they underwent revision LD within 2 years of the primary procedure. Visual analogue scale (VAS), Oswestry Disability Index (ODI), 12-item Short Form Health Survey and 12-item Veterans RAND physical component score (SF-12 PCS and VR-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were recorded. Delta PROM scores were evaluated for differences between groups and as a risk factor for a revision LD.
Results The study included 135 patients, 91 undergoing a primary procedure only and 44 undergoing a primary and revision procedure. Matched patients did not demonstrate any significant differences in demographics or perioperative characteristics. Patients who underwent a revision had a mean time to revision of 7.4 ± 5.7 months. Primary cohort significantly improved for all PROMs (all p < 0.05), while the primary plus revision cohort significantly improved for VAS back, ODI, and PROMIS-PF (all p < 0.05). However, cohorts differed in VAS back and PROMIS-PF (p < 0.05). Delta PROMs were not a significant risk factor for revision except at 6 months for PROMIS-PF (p = 0.024).
Conclusion LD has been associated with reliable outcomes, but early identification of patients at risk for revision is critical. This study suggests that tools such as PROMIS-PF may serve a role in predicting who is at risk and the 6-month follow-up period may be valuable for counseling patients who are not experiencing improvement.
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Objective Assess preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) scores and differences between preoperative and postoperative PROMIS-PF scores for patients undergoing anterior cervical discectomy and fusion (ACDF).
Methods After Institutional Review Board approval, a prospectively maintained surgical registry was retrospectively reviewed for elective spine surgeries of nontraumatic, degenerative pathology between 2015–2018. Inclusion criteria were primary or revision, single-level ACDF procedures. Multilevel procedures and patients without preoperative surveys were excluded. A preoperative PROMIS score cutoff of 35 divided patients into PROMIS-PF score categories (e.g. , ≥ 35.0, < 35.0). Categorical and continuous variables were evaluated with chi-square tests and t-tests. Linear regression analyzed PROMIS-PF score improvement.
Results Eighty-six patients were selected, the high and low PROMIS-PF subgroups only differed in mean age (49.1 vs. 41.3, p = 0.002). Significant differences in PROMIS-PF scores were observed among high and low preoperative PROMIS-PF score subgroups at 6 weeks (p = 0.006), 12 weeks (p = 0.006), and 6 months (p = 0.014). Mean differences between preoperative and postoperative PROMIS-PF scores were significantly different between the high and low PROMIS-PF subgroups at 6 weeks (p = 0.041) and 1 year (p = 0.038). A significant negative association was observed between preoperative PROMIS scores and magnitude of improvement at the 6-week postoperative time point (slope = -0.6291, p < 0.001).
Conclusion Patients with low preoperative PROMIS-PF scores demonstrated greater improvements at 6 weeks and 1 year. Clinicians should consider patients with low preoperative PROMIS-PF scores to be in the unique position to potentially experience larger postoperative improvement magnitudes than patients with higher preoperative PROMIS-PF scores.
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Objective To assess the relationship of preoperative physical function, as measured by Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF), to improvement in mental health, as evaluated by Short Form-12 Mental Component Summary (SF-12 MCS) following anterior cervical discectomy and fusion (ACDF).
Methods Patients undergoing primary ACDF were retrospectively reviewed and stratified based on preoperative PROMIS PF scores. PROMIS PF cohorts were tested for an association with demographic characteristics and perioperative variables using chi-square analysis and multivariate linear regression. Multivariate linear regression was utilized to determine the association between PROMIS PF cohorts and improvement in SF-12 MCS.
Results A total of 129 one- to 3-level ACDF patients were included: 73 had PROMIS PF < 40 (“low PROMIS”) and 56 had PROMIS PF ≥ 40 (“high PROMIS”). The low PROMIS cohort reported worse mental health preoperatively and at all postoperative timepoints except for 1 year. Both cohorts had similar changes in mental health from baseline through the 6-month follow-up. However, at 1 year. postoperatively, the low PROMIS cohort had a statistically greater change in mental health score.
Conclusion Patients with worse preoperative physical function reported significantly worse preoperative and postoperative mental health. However, patients with worse preoperative physical function made significantly greater improvements in mental health from baseline. This suggests that patients with worse preoperative physical function can still expect significant improvements in mental health following surgery.
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Martin Nikolaus Stienen, Nicolai Maldaner, Marketa Sosnova, Holger Joswig, Marco Vincenzo Corniola, Luca Regli, Gerhard Hildebrandt, Karl Schaller, Oliver Pascal Gautschi
Neurospine 2020;17(1):270-280. Published online January 26, 2020
Objective The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today’s gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure.
Methods We evaluated patients with lumbar DDD from a prospective 2-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 [normal] –0 [no movement]). The PROM-based evaluation included pain (visual analogue scale), disability (Oswestry Disability Index [ODI] & Roland-Morris Disability Index [RMDI]), and health-related quality of life (HRQoL; Short-Form 12 physical component summary/mental component summary & EuroQol-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value.
Results One hundred five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI: 52.8 vs. 48.2, p = 0.025; RMDI: 12.6 vs. 11.3, p = 0.034) but similar pain and HRQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p = 0.006). When comparing patients with high- (BMRC 0–2) vs. low-grade LEMD (BMRC 3–4), no difference was evident for the PROM-based evaluation (all p > 0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p = 0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs.
Conclusion Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable.
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Objective To investigate three-planar radiographic results and patient-reported outcomes (PROs) after correcting chronic atlantoaxial instability (AAI) by translaminar screw (TLS) and pedicle screw (PS) fixation, and to explore the potential association of atlantoaxial realignment with PRO improvements.
Methods Twenty-three patients who underwent C1 lateral mass screw (LMS)-C2 TLS and 29 who underwent C1 LMS-C2 PS with ≥ 2 years of follow-up were retrospectively analyzed. Three-planar (sagittal, coronal, and axial) radiographic parameters were measured. PROs including the Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score and the Short Form 36 Physical Component Summary (SF-36 PCS) were documented. Factors potentially associated with PROs were identified.
Results The radiographic parameters significantly changed postoperatively except the C1–2 midlines’ intersection angle in the TLS group (p = 0.073) and posterior atlanto-dens interval in both groups (p = 0.283, p = 0.271, respectively). The difference in bilateral odontoid lateral mass interspaces at last follow-up was better corrected in the TLS group than in the PS group (p = 0.010). Postoperative PROs had significantly improved in both groups (all p < 0.05). Thereinto, NDI at last follow-up was significantly lower in the TLS group compared with PS group (p = 0.013). In addition, blood loss and operative time were obviously lesser in TLS group compared with PS group (p = 0.010, p = 0.004, respectively). Multivariable regression analysis revealed that a change in C1–2 Cobb angle was independently correlated to PROs improvement (NDI: β = -0.435, p = 0.003; JOA score: β = 0.111, p = 0.033; SF-36 PCS: β = 1.013, p = 0.024, respectively), also age ≤ 40 years was independently associated with NDI (β = 5.40, p = 0.002).
Conclusion Three-planar AAI should be reconstructed by C1 LMS-C2 PS fixation, while sagittal or coronal AAI could be corrected by C1 LMS-C2 TLS fixation. PROs may improve after atlantoaxial reconstruction in patients with chronic AAI. The C1–2 Cobb angle is an independent predictor of PROs after correcting chronic AAI, as is age ≤ 40 years for postoperative NDI.
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