Abstract
BackgroundThe surgical outcomes of anterior cervical discectomy and fusion (ACDF) in female patients according to menopausal status remain unclear. The objective of this study was to investigate the differences in these outcomes among female patients with different menopausal statuses.MethodsNinety-one patients undergoing single-level or consecutive two-level ACDF with a minimum 12-month postoperative follow-up were included in this study. There were 38 patients in the premenopausal group, 28 patients in the early postmenopausal group, and 25 patients in the late postmenopausal group. The clinical outcomes were evaluated by means of the neck disability index (NDI) scores, Japanese Orthopedic Association (JOA) scores, and visual analog scale (VAS) scores. Radiological parameters included cervical lordosis (CL), the functional spinal unit (FSU) angle, range of motion (ROM) of the total cervical spine, ROM of the FSU, anterior and posterior FSU height, implant subsidence, adjacent segment degeneration (ASD), and Hounsfield unit (HU) values.ResultsAll groups showed significant improvements in their JOA, VAS, and NDI scores (P < 0.05). The differences in preoperative and final follow-up CL, ROM of C2-7, FSU angle, and ROM of FSU were not statistically significant among the three groups (P > 0.05). The anterior FSU height loss rate showed a significant difference (P = 0.043), while there was no difference in the posterior FSU height loss rate (P = 0.072). The fusion rates in the early and late postmenopausal groups were consistently lower than those in the premenopausal group during the follow-up period. All patients had satisfactory outcomes at the final follow-up.ConclusionThere were no significant differences in clinical or other related outcomes of single-level or consecutive two-level ACDF in the long term among female patients with different menopausal statuses. However, the early bony fusion rates and anterior FSU height loss rates were poorer in late postmenopausal patients than in premenopausal or early postmenopausal patients. Hence, importance should be attached to the protection of late postmenopausal patients in the early postoperative period to guarantee solid bony fusion.
Highlights
Cervical degenerative disc disease (CDDD) is a chronic, progressive, and age-related disorder that often presents with mechanical neck pain, radiculopathy, myelopathy, or a combination of these symptoms [1]
Strong and biomechanical secure fusion after Anterior cervical discectomy and fusion (ACDF) is critical to obtaining a satisfactory outcome in the long term, and faster fusion is combined with a lower risk of implant failure [6,7,8]
In the early postmenopausal years (< 10 years after menopause), the bone loss rate is nearly triple that of women in their premenopausal years and thereafter decreases to the premenopausal rate for the hip and to zero for the lumbar spine [13]; this indicates that menopause affects bone metabolism but does not necessarily cause osteoporosis and may have an influence on the fusion rates, subsidence rates, and other outcomes of female patients who have undergone ACDF
Summary
Cervical degenerative disc disease (CDDD) is a chronic, progressive, and age-related disorder that often presents with mechanical neck pain, radiculopathy, myelopathy, or a combination of these symptoms [1]. Menopause, namely, the time when menstruation and ovulation cease permanently, is a unique physiological process and an expected life event in women [15,16,17,18] Because of this physiological change, the prevalence of osteoporosis among women aged > 50 years is significantly greater than that in men [19]. In the early postmenopausal years (< 10 years after menopause), the bone loss rate is nearly triple that of women in their premenopausal years and thereafter decreases to the premenopausal rate for the hip and to zero for the lumbar spine [13]; this indicates that menopause affects bone metabolism but does not necessarily cause osteoporosis and may have an influence on the fusion rates, subsidence rates, and other outcomes of female patients who have undergone ACDF. The objective of this study was to investigate the differences in these outcomes among female patients with different menopausal statuses
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