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The Effect of ACDF or Arthroplasty on Cervicogenic Headaches: A Post Hoc Analysis of a Prospective, Multicenter Study With 10-Year Follow-up.

TitleThe Effect of ACDF or Arthroplasty on Cervicogenic Headaches: A Post Hoc Analysis of a Prospective, Multicenter Study With 10-Year Follow-up.
Publication TypeJournal Article
Year of Publication2020
AuthorsLombardi JM, Vivas AC, Gornet MF, Lanman TH, McConnell JR, Dryer RF, J Burkus K, K Riew D
JournalClin Spine Surg
Volume33
Issue9
Pagination339-344
Date Published2020 Nov
ISSN2380-0194
Abstract

STUDY DESIGN: This was a post hoc analysis of a prospective FDA-IDE study.

OBJECTIVE: The purpose of this study is to determine the effectiveness of a 2-level anterior cervical discectomy and fusion (ACDF) or cervical disk arthroplasty (CDA) at relieving headaches associated with cervical radiculopathy or myelopathy at 10 years postoperative.

BACKGROUND: To our knowledge, there is no large, prospective study that has examined the efficacy of cervical spine surgery for relieving headaches associated with radiculopathy or myelopathy at 10 years postoperative.

MATERIALS AND METHODS: This was a post hoc analysis of a prospective FDA-IDE study for the Prestige LP versus ACDF for radiculopathy or myelopathy due to 2 levels. Preoperatively and out to 10 years, their Neck Disability Index documented if they had headaches (0: no headaches; 1: infrequent slight; 2: infrequent moderate; 3: frequent moderate; 4: frequent severe; 5: nearly constant).

RESULTS: Three hundred ninety-seven patients were randomized to CDA (209) or ACDF (188). Preoperatively 86% had headaches and 55.9% (52.2% of CDA, 60.1% of ACDFs) had frequent moderate, severe, or nearly constant headache (grades 3-5). By 6 weeks postoperative, 64.4% had headaches and only 12.5% had grades 3-5 headaches (9.3% of CDA and 16% of ACDFs). The benefit lasted to the 10-year follow-up such that 60.3% had any headaches and 16.8% had grades 3-5 headaches (10.9% CDA; 24.3% ACDF).

CONCLUSIONS: These results suggest that 86% of patients with radiculopathy or myelopathy complain of headaches preoperatively, with 55.9% having frequent or constant, moderate to severe headaches (grades 3-5). By 6 weeks postoperative, only 12.5% had grades 3-5 headaches. At 10-year follow-up, 16.8% had grades 3-5 headaches. Both arthroplasty and ACDF are often effective at alleviating headaches associated with radiculopathy or myelopathy.

DOI10.1097/BSD.0000000000001087
Alternate JournalClin Spine Surg
PubMed ID32991361