Young adults undergoing ACDF surgery exhibit decreased health-related quality of life in the long term in comparison to the general population

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Hirvonen , T , Marjamaa , J , Siironen , J , Koskinen , S , Niemelä , M & Koski-Palken , A 2021 , ' Young adults undergoing ACDF surgery exhibit decreased health-related quality of life in the long term in comparison to the general population ' , The spine journal : official journal of the North American Spine Society , vol. 21 , no. 6 , pp. 924-936 . https://doi.org/10.1016/j.spinee.2021.01.021

Title: Young adults undergoing ACDF surgery exhibit decreased health-related quality of life in the long term in comparison to the general population
Author: Hirvonen, Tuomas; Marjamaa, Johan; Siironen, Jari; Koskinen, Seppo; Niemelä, Mika; Koski-Palken, Anniina
Contributor organization: Neurokirurgian yksikkö
HUS Neurocenter
Department of Neurosciences
Clinicum
HUS Helsinki and Uusimaa Hospital District
Date: 2021-06
Language: eng
Number of pages: 13
Belongs to series: The spine journal : official journal of the North American Spine Society
ISSN: 1529-9430
DOI: https://doi.org/10.1016/j.spinee.2021.01.021
URI: http://hdl.handle.net/10138/332814
Abstract: BACKGROUND CONTEXT: The leading surgical treatment of cervical radiculopathy is anterior cervical discectomy and fusion (ACDF). However, it has been suggested that ACDF procedures could lead to accelerated degeneration of the adjacent cervical discs (adjacent segment disease, or ASD) and the effect of ACDF surgery on neck symptoms and quality of life in the long term is not fully understood. Patients operated on at young ages generally have a long life expectancy and a long number of working years ahead of them. Thus, this patient group is of special interest when considering the accumulation of cervical problems due to possible ASD, the overall progressive nature of cervical degeneration in the long term, and their effects on related quality of life. PURPOSE: Our goal was to study the health-related quality of life in the long-term follow-up after ACDF surgery in the young adult population between the ages of 18 and 40. STUDY DESIGN: A retrospective cohort study with propensity matched controls. PATIENT SAMPLE: All patients between 18 and 40 years of age at the time of the surgery who underwent ACDF due to degenerative cervical disease at Helsinki University Hospital between the years 1990 and 2005 who had filled in the quality of life questionnaires 12 to 28 years after the surgery (281 patients), and a propensity matched control cohort of the general population selected based on age, sex, and smoking status. OUTCOME MEASURES: Quality of life measured by the EuroQol questionnaire (EQ-5D-3L and EQ-VAS). METHODS: The medical records of all patients who underwent ACDF due to degenerative cervical disease at the age of 18 to 40 years at Helsinki University Hospital between 1990 and 2005 were analyzed retrospectively. The EuroQol questionnaire was sent to all patients whose contact information could be obtained (443 patients) at the end of the follow-up (median 17.5 years) to assess their current quality of life. A total of 281 patients returned the questionnaires and were included in this study. Quality of life was compared to that in the general Finnish population using a similar sized control cohort selected through propensity matching. RESULTS: The patients who had undergone ACDF surgery reported significantly more problems than the general population cohort in three out of five dimensions that were assessed in the EQ-5D questionnaire, including mobility, usual activities, and pain/discomfort. Similarly, the overall EQ-5D-3L index calculated from the dimensional values was lower (0.74 vs. 0.83, p=.000), depicting a generally decreased health-related quality of life among patients. Spondylosis as a primary diagnosis, clinical myelopathy, and further cervical surgeries were associated with lower quality of life in the subgroup analyses of the patients. Similarly, in the EQ-VAS assessment, patient subgroups with spondylosis as a primary diagnosis, at least one reoperation, operation on more than one level, and clinical myelopathy were associated with lower scores and lower quality of life. The mean EQ-VAS score among patients was 73%. Regardless of the decreased health-related quality of life, there was no statistically significant difference in the concurrent employment status between the patient and control groups. CONCLUSIONS: The health-related life quality measured by the EQ-5D-3L was lower in the patient population than in the general population. Patients had more problems with mobility and usual activities and more pain/discomfort. However, satisfaction with the surgery was very high, and there was no significant difference in employment status between the patients and the control population. Patients with spondylosis as a primary diagnosis had lower quality of life compared to patients with disc herniation. Also, clinical myelopathy and further cervical surgeries during follow-up were associated with lower quality of life in the subgroup analyses of the patients. It must also be kept in mind that we do not know what the situation could have been without surgery and with conservative treatment only. (C) 2021 The Authors. Published by Elsevier Inc.
Subject: Anterior decompression
Cervical disc herniation
Cervical spondylosis
Long-term outcome
Quality of life
ANTERIOR CERVICAL DISKECTOMY
SMITH-ROBINSON PROCEDURE
AUTOLOGOUS ILIAC CREST
FOLLOW-UP
FUSION
DISEASE
3112 Neurosciences
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: publishedVersion


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