P123. Clinically important difference in neck pain and disability with cervical plating for anterior cervical discectomy and fusion

Abstract

<h3>BACKGROUND CONTEXT</h3> Previous studies have compared outcomes of anterior cervical discectomy and fusion (ACDF) with stand-alone interbody cage versus interbody cage with an anterior cervical plate. However, the impact of cervical plating has not been explored in terms of achievement of a minimum clinically important difference (MCID). <h3>PURPOSE</h3> To compare the impact of cervical plating on achievement of MCID up to 2-years following ACDF. <h3>STUDY DESIGN/SETTING</h3> Retrospective Cohort. <h3>PATIENT SAMPLE</h3> A total of 197 patients undergoing primary, single-level ACDF procedures with 102 receiving anterior cervical plating with interbody cage and 95 receiving a stand-alone cage. <h3>OUTCOME MEASURES</h3> Patient demographic characteristics, preoperative spinal diagnoses, perioperative information, Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), the 12-Item Short Form physical component summary (SF-12 PCS), Visual Analogue Scale (VAS) neck and VAS arm and Neck Disability Index (NDI). <h3>METHODS</h3> A database was queried for primary, single-level ACDF procedures. Patients were grouped based on whether their procedure included application of an anterior, intervertebral plate. Patient demographic characteristics, preoperative spinal diagnoses, and perioperative information were recorded. PROMs including Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), the 12-Item Short Form physical component summary (SF-12 PCS), Visual Analogue Scale (VAS) neck and VAS arm, and Neck Disability Index (NDI) were administered at preoperative and postoperative timepoints. Demographics, preoperative spinal diagnoses, and perioperative characteristics were compared between plating groups using chi squared and t-tests for categorical and continuous variables, respectively. Improvement in PROM scores was calculated as the difference between preoperative scores and each postoperative score. Achievement of an MCID was assessed using the following previously established thresholds: PROMIS-PF 4.5, SF-12 PCS 8.1, VAS neck 2.6, VAS arm 4.1, NDI 8.5. Rates of MCID achievement were compared between groups using a chi squared test. <h3>RESULTS</h3> Of 197 patients, 102 received plating and 95 received no plating. The mean cohort age was 47.2 years, 58.8% were male, and 47.2% were obese. Plating status was significantly associated with Charlson Comorbidity Index (p=0.003) and insurance status (p=0.014). Operative length and estimated blood loss were significantly greater for the plating group (p<0.001). The no-plating group demonstrated significant improvements at all postoperative timepoints for VAS neck, VAS arm, and NDI (all p≤0.004), through 1-year forSF-12 PCS (all p≤0.48), and at 12-weeks (p=0.005), 6-months (p=0.022), and 2-years (p=0.030) for PROMIS-PF. In the plating group, significant improvements were demonstrated in VAS neck through 1-year (all p ≤0.025), VAS arm through 6-months (all p<0.001), NDI at 12-weeks and 6-months (both p<0.001), and SF-12 PCS and PROMIS-PF from 12-weeks through 2-years (all p≤0.027). Significant intergroup differences in PROM improvement were demonstrated only for VAS neck and NDI at 6-weeks (p=0.011, p=0.010). Rates of MCID achievement differed significantly between groups for PROMIS-PF at 6-months (p=0.009), VAS neck overall (p=0.006), and NDI at 6-weeks (p=0.033), 12-weeks (p=0.020), and overall (p=0.004). <h3>CONCLUSIONS</h3> Patients improved significantly in terms of pain, disability and physical function, regardless of plating status, and with the exception of early neck pain and disability, these improvements were similar between groups. However, patients that underwent plating as part of their ACDF procedure achieved an MCID for neck pain and disability at lower rates. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.