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Functional Neurological Disorder is Associated with Postoperative Complications After ACDF: A Retrospective
Samuel A Florentino1, Christopher J Kaszluga2, Vu Bui2
1Case Western/University Hospitals, Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106.
Neuro-Chirurgie
|August 6, 2026
Summary
Functional Neurological Disorder (FND) increases risks for complications after anterior cervical discectomy and fusion (ACDF). Patients with FND experienced higher rates of dysphagia, infection, and longer hospital stays, along with long-term issues like pseudoarthrosis and opioid use disorder.
Area of Science:
- Neurosurgery
- Psychiatry
- Health Services Research
Background:
- Psychiatric comorbidities negatively impact surgical outcomes.
- Functional Neurological Disorder (FND), a neuropsychiatric condition, has not been studied in relation to cervical spine surgery outcomes.
- Investigating FND's impact is crucial for understanding and improving patient care.
Purpose of the Study:
- To determine the association between FND and perioperative complications after ACDF.
- To evaluate the long-term complications in patients with FND undergoing ACDF.
- To identify specific risks associated with FND in the ACDF population.
Main Methods:
- Retrospective cohort study utilizing the TriNetX US Collaborative Network (2004-2023).
- Analysis of adult patients (≥18 years) undergoing primary ACDF.
- 1:1 propensity score matching comparing patients with and without pre-existing FND.
Main Results:
- FND was present in 0.56% of 89,338 ACDF patients.
- Within 90 days, FND correlated with higher odds of dysphagia, surgical site infection (SSI), ED visits, and hospitalization.
- At 2 years, FND was linked to increased odds of pseudoarthrosis and opioid use disorder.
Conclusions:
- FND is associated with significantly increased perioperative and long-term complications following ACDF.
- Key complications include dysphagia, SSI, pseudoarthrosis, and opioid use disorder.
- Preoperative identification of FND is recommended for tailored management and multidisciplinary care to mitigate risks.