Cervical disc replacement treatment: where is it more effective—axial neck pain or radicular arm pain? The authors of a new study suggested that the difference, IF it exists, merits examination.
“Although anterior cervical discectomy and fusion is believed to positively impact a patient’s radicular symptoms as well as axial neck pain, the outcomes of cervical disc replacement with regards to neck pain specifically have not been established,” the study authors wrote.
For the retrospective review, the research team from Hospital for Special Surgery (HSS) evaluated clinical outcomes after cervical disc replacement in patients with neck pain greater than arm pain. They also compared outcomes for patients with predominant neck pain with those with predominant arm pain and equal neck and arm pain.
Study participants included 125 patients who had undergone one- or two-level cervical disc replacement for the treatment of degenerative cervical pathology and had a minimum of 6-month follow-up. Fifty-two of the patients had predominant neck pain, 30 had predominant arm pain and 43 were experiencing equal neck and arm pain.
The researchers analyzed all patient-reported outcomes including Neck Disability Index, Visual Analog Scale neck and arm, Short Form 12-Item Physical Health Score, Short Form 12-Item Mental Health Score and minimal clinically important difference.
The patients with predominant neck pain demonstrated significant improvements in early and late Neck Disability Index and Visual Analog Scale-Neck, early Short Form-12 Mental Health Score, and late Short Form-12 Physical Health Score.
The other two cohorts demonstrated significant improvements in all patient-reported outcomes at both the early and late timepoints. The researchers didn’t find any statistically significant differences in the minimal clinically important difference achievement rates for Neck Disability Index, Visual Analog Scale-Neck, Short Form-12 Physical Health Score, and Short Form-12 Mental Health Score at the late timepoint amongst the three groups.
Overall, the researchers found that cervical disc replacement leads to comparable improvement in neck pain and disability in patients presenting with neck pain greater than arm pain.
Lead author Sheeraz Qureshi, M.D., M.B.A, Patty and Jay Baker Endowed Chair, Minimally Invasive Spinal Surgery and Co-chief of Spine Service at the Hospital for Special Surgery, told OTW, “Understanding the best treatment for neck pain (irrespective of type of surgical or nonsurgical intervention) is difficult. In general, when we perform surgical interventions in the cervical spine, we often tell patients that arm pain is more likely to get better than neck pain. Furthermore, if neck pain is a major component of a patient’s symptoms, then surgeons will often suggest fusion as the best option.”
He added, “I was pleasantly surprised that patients who underwent cervical disc replacement did indeed have improvement in their neck pain (as well as their arm pain). Thus, surgical intervention, and specifically cervical disc replacement, which is a motion preserving surgical alternative, can be considered in patients with neck pain when a surgeon believes surgery would be helpful.”
The study, “Outcomes of cervical disc replacement in patients with neck pain greater than arm pain,” is published in the September 01, 2022 of The Spine Journal.
Study authors included Shahi Pratyush, M.B.B.S., M.S., Avani S. Vaishnav, M.B.B.S., Ryan Lee, M.B.A, Michael E. Steinhaus, M.D., Russel Huang, M.D., Todd Albert, M.D., Sravisht Iyer, M.D., Evan D. Sheha, M.D., James E. Dowdell, M.D., and Sheeraz A. Qureshi, M.D., M.B.A., all of the Hospital for Special Surgery in New York. Eric Mai, B.S. of the Weill Cornell Medical College in New York also contributed to the research.
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