Indicators for Substantial Neurological Recovery Following Elective Anterior Cervical Discectomy and Fusion

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Anterior cervical discectomy and fusion (ACDF) reliably improves neck and arm pain.
• The extent and pattern of motor recovery after ACDF are not well-defined.

Purpose of the Study:

• To determine the rate of motor improvement in patients with preoperative weakness undergoing ACDF.
• To identify risk factors associated with a failure to improve motor strength.
• To characterize the motor recovery of individual muscle groups post-ACDF.

Main Methods:

• Retrospective review of 618 patients undergoing 1-4 level ACDF.
• Patients were categorized based on preoperative motor grade (<4 defined as significant weakness).
• Analysis of clinical notes for muscle group involvement, recovery rates, and risk factors.

Main Results:

• 4.4% of patients (27/618) had significant preoperative weakness.
• 70.3% of affected patients achieved complete strength recovery post-ACDF.
• Motor recovery rates varied by muscle group: triceps (85.7%), finger flexors (83.3%), hand intrinsics (83.3%), biceps (50.0%), deltoids (25.0%).

Conclusions:

• High rates of motor recovery are expected for patients with preoperative weakness after ACDF.
• Myelomalacia (OR 28.9) and multi-level ACDF (OR 10.1) are significant risk factors for poor motor improvement.
• Deltoid weakness, myelomalacia, and >2 ACDF levels are associated with reduced likelihood of significant motor recovery.