79. Does facet distraction affect patient outcomes after ACDF?

Abstract

<h3>BACKGROUND CONTEXT</h3> Intervertebral distraction in anterior cervical discectomy and fusion (ACDF) leads to indirect nerve decompression but has been associated with facet joint over-distraction that may lead to postoperative axial neck pain. <h3>PURPOSE</h3> The aim of this study is to determine if there is a correlation between the amount of facet distraction and postoperative patient-reported outcomes after ACDF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> All patients over age 18 who underwent one- to three-level ACDF for cervical spondylosis with associated radiculopathy and/or myelopathy at a single academic institution between 2010- 2015 were retrospectively identified. Patients with a traumatic injury, infection, malignancy, revision procedures or incomplete medical records were excluded. <h3>OUTCOME MEASURES</h3> Postoperative short- and long- term health-related quality of life outcomes: Neck Disability Index (NDI), Short Form-12 (SF-12), VAS Neck pain, and VAS Arm pain scores. Delta outcome, recovery ratio and %MCID achievement. <h3>METHODS</h3> A retrospective cohort analysis of patients undergoing ACDF for degenerative pathologies at a single academic center was performed. Each patient received upright, lateral cervical spine x-rays at the immediate postoperative time point from which interfacet distance (facet distraction) was measured. Patient-reported outcome measures were obtained preoperatively and at short-term (<3 months) and long-term (>1 year) follow-up. Receiver operating curves were generated to evaluate the possibility of a critical interfacet distraction distance. Univariate and multivariate analysis were performed to compare outcomes between groups based on the degree of facet distraction. <h3>RESULTS</h3> A total of 229 patients met the inclusion criteria. Receiver operating curves failed to yield a critical interfacet distraction distance associated with worse post-operative outcomes. Patients were instead grouped based on facet distraction distance below and above the third quartile (0.8mm-2.0mm, 2.0mm-3.7mm), with 173 and 56 patients in each respective group. Univariate analysis did not detect any statistically significant differences in outcome measures, recovery ratio, or % MCID achievement at short- and long-term follow-up between groups. Multivariate analysis also failed to demonstrate any significant differences between the facet distraction groups. <h3>CONCLUSIONS</h3> Increased interfacet distance did not correlate with increased neck pain or disability after an ACDF. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.