The long-term clinical outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement

OBJECTIVE: This retrospective study provides data on the long-term clinical outcomes of patients with either anterior cervical discectomy alone (ACD) or anterior cervical discectomy with intervertebral bone graft placement (ACDF). METHODS: A questionnaire was mailed to 525 patients who had undergone ACD (290 patients) or ACDF (235 patients) at least 2 years previously. All procedures were performed by University of Nebraska Medical Center faculty in the Section of Neurosurgery. The follow-up period averaged 8.1 years, with a range of 2 to 14 years. RESULTS: Two hundred sixty-two (49.9%) patients responded to the questionnaire. There was no demographic difference between respondents and nonrespondents (P > 0.05). Respondents who underwent ACDF reported fewer problems with pain than did those who underwent ACD (P < 0.05). A higher percentage of respondents with ACDF reported that they had normal function than did those who underwent ACD (P < 0.05). When limited to respondents who underwent first-time, single-level operations (191 patients), similar results were obtained for the pain parameter (P < 0.05) but not for the level of function (P = 0.25). Patients with longer follow-up periods had fewer problems with pain and better levels of function (P < 0.05). CONCLUSION: Patients who underwent ACD or ACDF did well and benefited from their operations. Those who underwent ACDF did better than those who underwent ACD. Length of follow-up was also an important predictor of current levels of function and pain.