A Novel Preoperative Radiographic Scoring System To Predict Postoperative Outcomes in Patients Undergoing Cervical Disc Replacement Surgery

Abstract

Abstract INTRODUCTION The purpose of this study was to use a novel scoring system to quantify the level of degenerative change within the disc space, uncus, and facet joints, and determine the impact of worsening degenerative changes on postoperative outcome. METHODS Preoperative lateral and AP radiographs were collected and scored by 3 spine surgeons based on disc height, facet arthrosis, and uncovertebral joint degeneration. Each of the categories was scored from 0 to 2. These scores were separately used in the analysis to assess which component correlated with outcomes of surgery. An overall score for preoperative radiographic assessment was calculated as the sum of these 3 scores and also used in the analysis. Surgical outcomes were assessed by 5 patient reported outcomes measures (PROMs); Visual Analogue Scale (VAS) arm, VAS neck, Neck Disability Index (NDI), and Short Form 12 Physical health (SF12-P) and mental health (SF12-M). RESULTS Radiographs of 85 patients that underwent CDR were assessed. Of those, 60 were single-level and 25 were two-level surgeries. A total of 44 patients were deemed to have adequate follow up, while 41 patients were excluded from the analysis due to inadequate follow-up. Interrater reliability for radiographic assessment was good to excellent. The included patients had a mean follow-up of 8 mo, ranging from 6 to 24 mo. At latest follow-up, preoperative facet arthrosis showed a statistically significant correlation with NDI and VAS neck outcomes measures (P = .016, P = .013, respectively). However, disc height and uncovertebral degeneration did not correlate with any of the collected PROMs (P > .05 for all). CONCLUSION Preoperative health of the facet joint at the surgical level had a significant impact on patient perceived neck pain and disability at the latest follow up. It is important for patient selection to be refined to reflect a focus on factors that can impair success of CDR surgery.