A Comparison of Clinical Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion and Rotator Cuff Repair
Hannah A. Levy, BS1, Brian A. Karamian, MD1*, Paul D. Minetos, MD, MBA1, Michael J. Gutman, MD1, Joshua Pezzulo, BS1, Jose A. Canseco, MD, PhD1, Barrett I. Woods, MD1, Mark F. Kurd, MD1, Jeffrey A. Rihn, MD1, Alan S. Hilibrand, MD1, Christopher K. Kepler, MD, MBA1, Alexander R. Vaccaro, MD, PhD, MBA1, Daniel E. Davis, MD, MS1 and Gregory D. Schroeder, MD1
1Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
*Corresponding Author: Brian A. Karamian, MD, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA, ORCID: 0000-0003-0512-6019
Received: April 14, 2022 Published: May 24, 2022
Abstract
Purpose: The purpose of this study was to determine the relative improvements in pain and functional status after ACDF versus RCR.
Methods: All patients over 18 years old who underwent primary one- to two-level ACDF for cervical radiculopathy and primary arthroscopic RCR for acute or chronic rotator cuff tears between 2010-2019 were retrospectively identified. Preoperative and one-year postoperative patient reported outcomes measures (PROMs) were extracted including SF-12 Physical and Mental Components (PCS, MCS) and VAS Arm pain after both interventions. Univariate analysis compared clinical outcomes, 90-day readmission rate, and revision rate between patients undergoing ACDF and RCR. Multivariate analysis compared PROM improvement across surgical groups.
Results: A total of 201 ACDF patients and 303 RCR patients met the inclusion/exclusion criteria. Patient age, CCI, sex, and smoking status differed significantly between groups. All PROMs improved significantly after ACDF and RCR. There were two readmissions and five revisions after RCR and neither after ACDF. Rotator cuff tear patients, compared to cervical radiculopathy patients, had significantly higher preoperative functional status and lower pain. RCR in comparison to ACDF was associated with significantly greater VAS Arm pain reduction and percent of patients achieving the minimal clinically important difference. Regression found RCR predicted greater VAS Arm pain improvement. However, PCS and MCS improvements were not statistically different across surgical interventions.
Conclusion: Rotator cuff repair, relative to ACDF for cervical radiculopathy, was associated with increased upper extremity pain reduction. However, improvements in functional status did not meaningfully differ between ACDF and RCR.
Keywords: Patient Outcomes, Arm Pain, Cervical Spine, Rotator Cuff Repair, Anterior Cervical Discectomy and Fusion
Citation: Levy HA, Karamian BA, Minetos PD, Gutman MJ, Pezzulo J, Canseco JA, Woods BI, Kurd MF, Rihn JA, Hilibrand AS, Kepler CK, Vaccaro AR, Davis DE, Schroeder GD. “A Comparison of Clinical Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion and Rotator Cuff Repair”. SVOA Orthopaedics 2022, 2:3, 61-68.