Patients Show Similar Recovery Metrics Measured by Health-related Quality-of-life Scores Despite Differences in CT-graphic Fusion Status One Year After 1-level and 2-level Anterior Cervical Discectomy and Fusion.

STUDY

DESIGN

Retrospective cohort study.

OBJECTIVE

To evaluate the clinical implications of an incomplete fusion status as determined by CT imaging at 1-year follow-up in patients who underwent anterior cervical discectomy and fusion.

BACKGROUND

Despite the advanced capabilities of CT imaging, a notable proportion of patients assessed at a 1-year follow-up are classified as having an incomplete fusion status. While neck pain is the most common symptom of pseudarthrosis after cervical fusion surgery, not all patients are symptomatic. Understanding the clinical relevance of this intermediate fusion status is essential to correctly interpret patient-reported outcome measurement instruments and patient-centered care.

METHODS

Retrospective data from patients who underwent 1-level or 2-level anterior cervical discectomy and fusion between 2017 and 2022 at our tertiary spine center were reviewed, assessing a total of 77 segments. Data collected included demographic information, 1-year follow-up CT fusion rate, patient-reported outcome measurements, complications, or revision surgery. Follow-up evaluations were conducted at postoperative, short-term, and long-term intervals. A backward stepwise logistic regression was utilized to identify independent predictors of fusion status.

RESULTS

At 1 year, 54% of patients showed signs of successful fusion, whereas 45% were categorized as incompletely fused. No significant differences were found between the fusion status groups regarding the achievement of minimal clinically important difference and patient-acceptable symptom state for clinical outcomes, including Neck Disability Index, Numeric Rating Scale arm/neck, and Short-Form 12 Physical Component Questionnaire scores. Although a higher percentage of IF patients were former smokers and, on average, had more levels fused, logistic regression did not identify these demographics, or any other variables, as significant independent predictors of fusion status.

CONCLUSIONS

Patients achieved meaningful pain relief during follow-up that was independent of their 1-year CT-graphic fusion status. Trends suggest that former smoking status and the number of fused levels may influence fusion outcomes, warranting further investigation.

LEVEL OF EVIDENCE: Level III.