| Summary: | MSc Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2009 === The cervical spine is subjected to wear and tear as well as trauma. This increases the
occurrence of degeneration of intervertebral discs and facet joints. Degeneration will result in
loss of disc height and the formation of osteophytes on adjacent vertebrae. Nerve roots can be
irritated or compressed by this pathology and patients can possibly develop neurological signs
and symptoms as well as pain. An anterior neck fusion is a surgical procedure that is frequently
used to manage cervical pathologies such as degeneration, spinal stenosis, disc herniation, or
trauma. Cervical pathologies can become severe and neural compression may develop.
Compression of neural components can present with symptoms such as muscle weakness,
numbness, tingling or radicular pain. The main aim of the surgery is to decompress the neural
structures, permanently stabilize the vertebrae, to maintain a cervical lordosis and to hold an
anatomical disc space.
Chronic spinal disorders, including cervical and lumbar conditions, are considered the most
expensive benign condition to manage. Previous research demonstrated poor functional
outcomes especially in the lumbar area. Little evidence is available regarding the functional
outcomes of patients after anterior neck fusion surgery. The aim of this study was to investigate
the levels of pain and the quality of life experienced by patients who had an anterior neck fusion
one year ago.
Methods
A cross – sectional survey was conducted. Neurosurgeons in the Johannesburg region were
contacted telephonically to establish whether they performed anterior neck fusion surgery.
Potential subjects were then identified and contacted to establish whether they suited the
inclusion criteria for the study. Pain was assessed using the Visual Analogue Scale. The Neck
Disability Index, Fear Avoidance Beliefs and Short Form-36 questionnaires were completed to
determine the levels of dysfunction, anxiety and depression as well as health related quality of
life in subjects who had an anterior neck fusion one year ago. The quality of life of these
subjects was then compared to that of a healthy baseline group.
Results and Discussion
Forty-two (n = 42) subjects were telephonically identified from the neurosurgeons’ records.
Thirty-five (n = 35) subjects met the inclusion criteria and participated in the study. Twenty-six
subjects were female (n = 26) with an average age of 54 years and nine (n = 9) were male with
an average age of 53 years. The demographic questionnaire demonstrated a high prevalence
v
for the use of pain- and anti-inflammatory medication (81.3%). According to the demographic
questionnaire, the subjects received on average six physiotherapy treatments postoperatively.
Most of the subjects (n = 22) demonstrated pain over the upper shoulder area as well as
posterior regions of the neck on the body chart. At the time of assessment, the subjects
indicated their level of pain using a VAS scale and had an average score of 35.48mm (SD ±
24.11) which indicated a low level of pain. Results obtained from the NDI questionnaire
indicated that the subjects had moderate disability one year postoperatively. The mean score on
the NDI for subjects was 31.10 (SD ± 11.96). Subjects did not demonstrate high scores on the
FABQ and had a mean score of 54.09 (SD ± 0.99). There were no significant differences
between the male and female groups for the FABQ. On the SF-36, the subjects had a moderate
reduction in mental health components of QoL [MCS = 42.19 (SD ± 13.31)] as well as the
physical health components of QoL [PCS = 46.78 (9.44)]. QoL of these subjects was compared
to a baseline group. Results showed a statistically significant difference between the groups for
all eight domains (p- values ranged between 0.0001 and 0.012). The mental health component
score (MCS) was not significantly different between the groups but subjects with anterior neck
fusion had a significantly lower score on the physical health component (PCS) than the baseline
group (p = 0.001).
Conclusion
This paper concluded that subjects who had an anterior neck fusion 12 months ago still suffered
from low levels of pain and moderate dysfunction. They reported low levels of QoL related to
physical health one year postoperatively.
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