1561. Effect of Surgery on Neck Pain in Degenerative Cervical Radiculopathy: A Canadian Spine Outcomes Research Network (CSORN) Study

Authors: Mark Alexander MacLean, MD, MSc; Ayoub Dakson; Fred Xavier, MD, PhD; Greg McIntosh, MSc; Sean Christie, MD, FRCSC; CSORN Investigators (Halifax, Canada)

Introduction: Neck pain (NP) is a leading cause of disability. Degenerative cervical radiculopathy (DCR) is commonly associated with significant NP, arm pain (AP), and disability. While improved AP is observed following surgery for DCR, NP is generally not felt to improve. A consensus does not exist on how to educate patients regarding expected reduction in NP.  The purpose of the study was to specifically quantify the improvement in NP following surgery for DCR.

Methods:

This is a multicenter, ambispective review of consecutive patients enrolled by the Canadian Spine Outcomes and Research Network (CSORN). Patients received surgery for DCR; subgroups included: 1-level, 2-level, 3-level ADCF or cervical disc arthroplasty (CDA). The primary patient reported outcome (PRO) measure was 12-month reduction in Visual Analogue Scale for Neck Pain (VAS-NP). Secondary PROs included: Neck Disability Index (NDI), Visual Analogue Scale for Arm Pain (VAS-AP), Short-Form Physical Health Composite Scale (SF-12-PCS) and Mental Health Composite Scale (SF-12-MCS).

Results:

We identified 79 patients with DCR: 1-level ACDF (38%), 2-level ACDF (35%), 3-level ACDF (8%) and CDA (19%). For all outcome measures, pre-operative PROs were similar across subgroups. For the combined subgroups, mean VAS-NP and VAS-AP improved by 3.6 points, respectively. Mean change from baseline in PROs was similar across subgroups, for all outcome measures (P>0.05). Percent reduction in VAS-NP compared to baseline ranged from 46-65%. VAS-AP was significantly reduced in all surgical groups (P<0.05). Only patients undergoing 2-level ACDF and CDA demonstrated significant improvement in VAS-NP (P<0.001). Mean change in VAS-NP was not significant for 1-level (P = 0.098) and 3-level ACDF (P = 0.132) groups, respectively.

Conclusion:

For patients undergoing surgery for DCR with similar pre-operative levels of disability, patients that underwent a 2-level ACDF or CDA demonstrated a statistically significant 12-month post-operative improvement in VAS-NP. VAS-AP was significantly reduced in all subgroups.