Highlights
- •The relationship between the clinical outcomes and facet distraction after anterior cervical discectomy and fusion (ACDF) remains unclear.
- •Δ Facet distraction measured using computed tomography strongly correlated with neck pain, and over-distraction contributed to adverse long-term outcomes, including neck and arm pain after ACDF.
- •An Δ over-distraction of ≥1.8 mm may cause radiculopathy of adjacent segments along with facet-mediated axial pain.
- •Cage height should be carefully determined to avoid over-distraction during ACDF.
Abstract
BACKGROUND CONTEXT
Anterior cervical discectomy and fusion (ACDF), the gold standard treatment for radiculopathy
and myelopathy, has the potential risk of inducing facet-mediated pain through over-distraction.
However, the relationship between the clinical outcomes and facet distraction after
ACDF remains unclear.
PURPOSE
To measure facet distraction using computed tomography (CT) and compare the results
with the clinical outcomes after ACDF.
STUDY DESIGN
Retrospective cohort study.
PATIENT SAMPLE
A consecutive series of patients (n = 144) who underwent a single-level ACDF were
included.
OUTCOME MEASURES
Interfacet distance on preoperative and postoperative lateral cervical radiographs
and CT. Visual analog scale for neck pain (VASn), and arm pain (VASa), neck disability
index (NDI), the Short Form 36-item health survey (SF-36) were used for clinical outcomes.
METHODS
Each patient underwent plain radiography of the lateral cervical spine preoperatively,
immediately and two years postsurgery. CT was performed preoperatively, and at 3 days
and 1-year postsurgery. The inter-facet distance was measured at each time point,
and changes in values from the preoperative distance were noted and used for study.
Patient-reported outcome measures were obtained preoperatively and at 2-year follow-up.
Receiver operating characteristic (ROC) curves were generated to derive the critical
facet distraction point.
RESULTS
The 3 weeks postoperative VASn score was the most severe and showed a tendency to
decrease during the follow-up period. There was a significant positive correlation
between the change value of facet distraction measured using CT and 3 weeks postoperative
VASn score. ROC curve analysis showed that the cut-off value of Δ facet distraction
was 1.8 mm. The over-distraction group (Δ facet distraction ≥1.8 mm, n = 75) showed
significantly worse clinical outcomes than the control group (Δ facet distraction
<1.8 mm, n = 69), including neck and arm pain VAS scores at all time points until
the final 2-year follow-up.
CONCLUSION
The change value of facet distraction measured using CT rather than plain radiography
correlated better with neck pain, and over-distraction contributed to adverse long-term
outcomes, including neck and arm pain after ACDF. Additionally, an over-distraction
of ≥1.8 mm may cause radiculopathy of adjacent segments along with facet-mediated
axial pain; therefore, cage height should be carefully determined to avoid over-distraction
during ACDF.
Keywords
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Article info
Publication history
Published online: February 14, 2023
Footnotes
FDA device/drug status: Not applicable
Author disclosure: DHL: Nothing to disclose. JYL: Nothing to disclose. HRL: Nothing to disclose. JWC: Nothing to disclose. CJH: Nothing to disclose. CSL: Nothing to disclose.
Identification
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