OUTCOME ANALYSIS OF NONINSTRUMENTED ANTERIOR CERVICAL DISKECTOMY AND INTERBODY FUSION IN 348 PATIENTS

Study Design. Twenty-one outcome and outcome-relevant variables (fusio n and patient satisfaction) were evaluated in a subset of 348 of 514 p atients operated on by one surgeon during a 22-year period, using Clow ard's anterior cervical discectomy and dowel interbody fusion. Minimum patient follow-up was 2 years; average length of follow-up was 5.2 ye ars. This retrospective analysis is accompanied by a comprehensive rev iew of the literature (1975-1996) of noninstrumented anterior cervical fusions, excluding fibular grafts alone in the interbody space. Objec tives. To provide data on outcome (with regard to patient satisfaction and radiologically supported fusion) and risks of noninstrumented ant erior cervical discectomy and fusion for intractable cervical nerve ro ot and spinal cord compression symptoms at single or multiple levels, using the results from a single surgeon. Methods. Three experienced sp ine radiologists determined fusion rates in one to five levels in 348 patients on the basis of the results of plain film analysis. Patient s elf-assessment was used to determine degree of patient satisfaction an d other related variables, From a comprehensive review of the literatu re, 43 clinical reports meeting requirements for comparison of finding s with those in the current study were elected from more than 1600 rep orts. Results. The mean fusion rate for 348 patients in the current st udy ranged from 75% (multilevel) to 88% (one level; n = 202). The over all fusion rate was 83%. The persistent complication rate was 0.1%, an d patient self-assessments showed that 78% were satisfied with the out come and that 83% returned to work. The overall fusion rate for 2037 p atients evaluated in the:comprehensive literature review is 92%. Concl usions. Results of this study indicate that better outcome in noninstr umented anterior cervical discectomy and fusion is associated with sol id fusion, fewer fused levels, nonsmoking patients, higher education l evels, and absence of secondary economic gain, There was no correlatio n between fusion status and bone graft source or use of cervical colla r.