Friday, September 28, 2018 10:30 AM–12:00 PM abstracts: complications of cervical spine surgery 158. The role of anterior cervical discectomy and fusion on relieving axial neck pain: a systematic review and meta-analysis

BACKGROUND CONTEXT Axial neck pain is a common issue leading to patient discomfort and substantial cost to the health-care system and the society. Without classical indications for surgical intervention such as radiculopathy or myelopathy, axial neck pain is treated conservatively. Therefore, we undertook a systematic review and meta-analysis to evaluate the efficacy of anterior cervical decompression and fusion (ACDF) on relieving axial neck pain. METHODS Two independent reviewers completed a librarian-assisted search of multiple databases including EMBASE, Medline, and the Cochrane Library. Retrieved studies included cohorts that had to be prospective studies reporting on pre- and postoperative neck pain scores. Visual Analogue Score (VAS), and Neck Disability Index (NDI) scores were extracted preoperatively, and at 3, 6, 12, 24 and 36 months postoperatively for patients undergoing a single level ACDF exclusively. We undertook a unique methodology by making all patients as their own control and comparing pre to postoperative VAS and NDI scores. We calculated weighted mean differences (MDs) with corresponding 95% confidence intervals (CIs) for VAS and NDI at different follow up intervals separately. RESULTS We identified 17,850 studies, after exclusion 37 prospective cohorts were deemed eligible. Among these, 53% of participants were male and the mean age of patients was 47.2 years. At 6 months VAS MD were reduced to −2.9 points (95%CI, −3.6 to −2.2; p<.001) and NDI MD reduction to −35.2 points (95%CI, −46.1 to −24.3; p<.001). At 2 years VAS MD were reduced to −4.7 points (95CI, −5.3 to −4.1; p<.001) and NDI −24.9 points (95CI, −30.0 to −19.7; p<.001). CONCLUSIONS Our results suggest that ACDF is associated with a substantial reduction in axial neck pain. These findings may inform future controlled randomized trials of the safety and efficacy of ACDF as a treatment option for patients with herniated cervical disc with axial neck pain without radiculopathy or myelopathy.