Young adults undergoing ACDF surgery exhibit decreased health-related quality of life in the long term in comparison to the general population
Autor: | Jari Siironen, Tuomas Hirvonen, Johan Marjamaa, Mika Niemelä, Anniina Koski-Palkén, Seppo Koskinen |
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Přispěvatelé: | Neurokirurgian yksikkö, HUS Neurocenter, Department of Neurosciences, Clinicum, HUS Helsinki and Uusimaa Hospital District |
Rok vydání: | 2020 |
Předmět: |
Adult
medicine.medical_specialty Adolescent Population Anterior decompression General Population Cohort Anterior cervical discectomy and fusion Intervertebral Disc Degeneration DISEASE 03 medical and health sciences Young Adult FUSION 0302 clinical medicine Quality of life Cervical disc herniation medicine Cervical spondylosis Humans Orthopedics and Sports Medicine ANTERIOR CERVICAL DISKECTOMY Young adult education Finland Retrospective Studies 030222 orthopedics education.field_of_study AUTOLOGOUS ILIAC CREST business.industry 3112 Neurosciences Retrospective cohort study 3126 Surgery anesthesiology intensive care radiology medicine.disease Long-term outcome 3. Good health Surgery Spinal Fusion Treatment Outcome SMITH-ROBINSON PROCEDURE Cohort Cervical Vertebrae Quality of Life Neurology (clinical) FOLLOW-UP business 030217 neurology & neurosurgery Diskectomy Follow-Up Studies |
Zdroj: | The spine journal : official journal of the North American Spine Society. 21(6) |
ISSN: | 1878-1632 |
Popis: | 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. |
Databáze: | OpenAIRE |
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