Anterior cervical discectomy and fusion for the management of axial neck pain in the absence of radiculopathy or myelopathy

Study design: Systematic review Study rationale: Anterior cervical discectomy and fusion (ACDF) is a proven, effective treatment for relieving neck pain due to degenerative conditions of the cervical spine. Since most patients also present with radiculopathy or myelopathy, little is known as to the effectiveness of ACDF to relieve pain and improve function in patients without radicular or myelopathic symptoms. Objective: To examine the clinical outcome in patients undergoing (ACDF) for axial neck pain without radicular or myelopathic symptoms. Methods: A systematic review was undertaken for articles published up to March 2010. Electronic databases and reference lists of key articles were searched to identify studies evaluating ACDF for the treatment of axial neck pain only. Radiculopathy and myelopathy, patients who suffered severe trauma, or with tumor / metastatic disease or infection were excluded. Two independent reviewers assessed the strength of evidence using the grading of recommendations assessment, develop­ment and evaluation (GRADE) system, and disagreements were resolved by consensus. Results: No comparative studies were identified. Three case series met our inclusion criteria and were evaluated. All studies showed a mean improvement of pain of at least 50 % approximately 4-years following surgery. Functional outcomes improved between 32 % and 52 % from baseline. Most patients reported satisfaction with surgery, 56 % in one study and 79 % in another. Complications varied among studies ranging from 1 % to 10 % and included pseudoarthrosis (9 %), nonunion and revision (3 %) and screw removal (1 %). Conclusion: There is low evidence suggesting that patients with axial neck pain without radicular or myelopathic symptoms may receive some improvement in pain and function following ACDF. However, whether this benefit is greater than nontreatment or other treatments cannot be determined with the present literature. STUDY RATIONALE AND CONTEXT ACDF is a commonly performed procedure for degenerative conditions of the cervical spine with a successful fusion rate of approximately 95 % and with overall good to excellent results 1, 3. The majority of patients present with combined complaints of axial neck pain with associated upper extremity radicular or myelopathic symptoms. There is considerable controversy, however, regarding the role of ACDF for neck pain without radiculopathy or myelopathy, and clinical outcome studies of ACDF with validated outcome measures in this patient population are scarce. OBJECTIVES To analyze the clinical outcome in patients treated with ACDF for axial neck pain in the absence of radiculopathy or myelopathy, especially with regard to changes in pain and function.