Is the efficacy of the Cloward procedure overestimated? Technique of evaluation affects the outcome

The purpose of the present study was to investigate the influence of the ev aluation technique on the outcome of the Cloward procedure in cervical radi culopathy. The retrospective study included 94 consecutive patients operate d on with anterior decompression and fusion with heterologous bone (Surgibo ne, Unilab). There were 56 men and 38 women, with a mean age of 48 years (r ange 27-78 years). Sixty-six patients had a single-level fusion, 26 a two-l evel fusion and one patient had a three-level fusion. The followup rate was 91/94 (97%) and evaluation was performed by an independent observer. Pain was quantified by visual analogue scale (VAS, range 0-100), functional disa bility by the new functional index Cervical Spine Functional Score (CSFS, r ange 0-100) and by the Neck Pain Disability Index (NPDI, range 0-100). The overall clinical outcome was assessed as excellent, good, fair or poor by b oth the patient and by the independent observer using Odom's criteria. At a mean follow-up of 26 months (range 12-56 months) the mean pain index was 3 9 (range 0-98), the mean CSFS 39 (range 0-85) and the mean NPDI 32 (range 0 -76). The classification of the observer was 37% excellent, 40% good, 17% f air and 6% poor, and that of the patient was 53% excellent, 23% good, 20% f air and 4% poor. In the group classified as good by the observer, all score s were above 40, suggesting considerable remaining symptoms, and only 50% h ad returned to work. The results suggest that previous reports on the Clowa rd procedure using categorizations into excellent, good, fair or poor have overestimated the efficacy of the procedure. Only an excellent, but not a g ood, result as classified by the patient or an independent observer reflect s a successful outcome. Neither of the variables studied seems independentl y sufficient for a balanced reflection of the outcome. The results suggest pain (VAS) as the primary outcome measurement, which, combined with the ove rall evaluation by the independent observer and work status, gives a multid imensional expression of the outcome.