Establishing Maximal Medical Improvement Following Anterior Cervical Discectomy and Fusion

Benjamin Khechen, BA1 ; Dil V. Patel, BS1; Anirudh K. Gowd, BS1; Mundeep S. Bawa, BA1; Harmeet S. Bawa, BA1; Jordan A. Guntin, BS1; Sailee S. Karmarkar, BS1;

Joseph N. Liu, MD1; Kern Singh, MD1,2

1Department of Orthopaedic Surgery, Rush University Medical Center2Professor, Co-Director of the Minimally Invasive Spine Institute at Rush University Medical Center;

Founder and President, Minimally Invasive Spine Study Group

Disclosures

Benjamin Khechen, Dil V. Patel, Anirudh K. Gowd, Mundeep S. Bawa, Harmeet S.

Bawa, Jordan A. Guntin, Sailee S. Karmarkar, Joseph N. Liu – Nothing to disclose

Kern Singh, MD

• Board Membership – Vital 5 LLC, Avaz Surgical LLC• Consultant – Depuy, Zimmer, Stryker• Royalties – Zimmer, Stryker, Pioneer, Lippincott Williams and Wilkins,

Thieme, Jaypee Publishing, Slack Publishing

• Grants – Cervical Spine Research Society

Background and Purpose

• The identification of a time point at which patients reach maximal medical improvement (MMI) allows providers to understand postoperative requirements and manage expectations of surgical patients

• To identify the time point at which patients undergoing primary, single-level anterior cervical discectomy and fusion (ACDF) can be considered to have reached MMI.

Methodology

● Retrospective review of a prospectively-maintained database

● 69 patients that underwent a primary, single-level ACDF for degenerative pathology from 2014 to 2017

Methodology

• Variables Analyzed• Patient demographics• Patient-Reported Outcomes

(PROs)■ Neck Disability Index

(NDI)

• Statistical Analyses• Pearson chi-square• Multivariate linear regression• Distribution-based MCID• Nonparametric receiver

operating characteristic (ROC) curve

• Kaplan-Meier survival analysis• Cox regression

Results

Patient demographics and baseline characteristics

Results

NDI improvements in ACDF patients ranging from preoperative to 12-months postoperatively

Results

Over 95% of patients reach MCID for NDI at 6 months

Discussion

● 95.7% achieved MCID by 6 months, allowing MMI to be established at this point.

Limitations

• Incomplete survey data beyond 1-year limited analysis of detecting

further improvement in NDI

• Other patient-reported outcomes, such as pain scores, were not

evaluated during this investigation

Conclusions

• The majority of patients (62.7%) achieved MCID by 6-weeks

• As over 95% of patients achieved MCID by 6-months postoperatively, this time point was determined to represent MMI

• Future outcome reporting in patients undergoing ACDF should include follow-up to 6 months postoperatively

References1. Segal DN, Wilson JM, Staley C, Yoon TS. Outpatient and Inpatient Single-Level Cervical Total Disc Replacement: A Comparison of 30-day

Outcomes. Spine. 2018;2. Inoue T, Ohara Y, Niiro T, Endo T, Tominaga T, Mizuno JI. Cervical Periosteal Chondroma Causing Spinal Cord or Nerve Compression: 2 Case

Reports and Literature Review. World Neurosurg. 2018;114:99-105.3. Harrison DE, Oakley PA, Betz JW. Anterior head translation following cervical fusion-a probable cause of post-surgical pain and

impairment: a CBP case report. J Phys Ther Sci. 2018;30(2):271-276.4. Wong KE, Chang PS, Monasky MS, Samuelson RM. Traumatic spondyloptosis of the cervical spine: A case report and discussion of

worldwide treatment trends. Surg Neurol Int. 2017;8:89.5. Lu VM, Zhang L, Scherman DB, Rao PJ, Mobbs RJ, Phan K. Treating multi-level cervical disc disease with hybrid surgery compared to

anterior cervical discectomy and fusion: a systematic review and meta-analysis. Eur Spine J. 2017;26(2):546-557.6. Somani S, Di capua J, Kim JS, et al. Comparing National Inpatient Sample and National Surgical Quality Improvement Program: An

Independent Risk Factor Analysis for Risk Stratification in Anterior Cervical Discectomy and Fusion. Spine. 2017;42(8):565-572.7. Bohl DD, Ahn J, Collins M, et al. Functional Capacity Evaluation Following Spinal Fusion Surgery. Spine. 2016;41(13):1104-10.8. Lukasiewicz AM, Basques BA, Bohl DD, Webb ML, Samuel AM, Grauer JN. Myelopathy is associated with increased all-cause morbidity and

mortality following anterior cervical discectomy and fusion: a study of 5256 patients in American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Spine. 2015;40(7):443-9.

9. Buerba RA, Giles E, Webb ML, Fu MC, Gvozdyev B, Grauer JN. Increased risk of complications after anterior cervical discectomy and fusion in the elderly: an analysis of 6253 patients in the American College of Surgeons National Surgical Quality Improvement Program database. Spine. 2014;39(25):2062-9.

10. Seicean A, Alan N, Seicean S, et al. Impact of increased body mass index on outcomes of elective spinal surgery. Spine. 2014;39(18):1520-30.

11. Lu Y, Qureshi SA. Cost-effective studies in spine surgeries: a narrative review. Spine J. 2014;14(11):2748-62.12. Fehlings MG, Barry S, Kopjar B, et al. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of

the prospective multicenter AOSpine North America CSM study in 264 patients. Spine. 2013;38(26):2247-52.

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