Comparing outcomes of anterior cervical discectomy and fusion in workman's versus XXXX population.

@entity1 @entity1538 @entity3976 @entity612 @entity1893 @entity1516
BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is an accepted surgical procedure to treat degenerative conditions, including disc @entity3976 and @entity612 . The literature on lumbar spine surgery reports that @entity1 with a @entity1538 claim have less successful clinical results. Regarding the cervical spine, however, different conclusions have been drawn. PURPOSE: The purpose of this study was to directly compare the functional outcomes of ACDF in @entity1 with and without a @entity1538 claim and to determine whether a compensation claim adversely affected the clinical outcome. STUDY DESIGN: This is a retrospective study examining the long-term results of ACDF in the workman's and @entity1893 populations. @entity1 SAMPLE: Eighty consecutive @entity1 undergoing ACDF were retrospectively analyzed. The @entity1 were divided into two groups: 30 @entity1 in Group 1 ( @entity1538 ) and 50 @entity1 in Group 2 ( @entity1893 ). The average age of Group 1 was 45 years (range, 31 to 57) and Group 2 was 45 years (range, 30 to 79). The @entity1 were followed for an average length of 4 years (range, 2 to 7 years). OUTCOME MEASURES: We evaluated the surgical results using a functional outcome scoring system (Odom's Criteria), visual analog scale and a radiographic grading scale. The questionnaire was independently administered in a standard question-answer format at the 1-year follow-up. Statistical analyses was performed using a Levene's test. METHODS: All surgeries were performed by the same attending physician. A left-sided approach and Smith-Robinson fusion technique with autograft or allograft without instrumentation was used in all cases. A hard cervical orthosis was used postoperatively for 8 weeks. Radiographic examination including lateral flexion and extension views were obtained at a minimum of 12 months postoperatively. Furthermore, radiographic analysis was performed each subsequent postoperative year. The radiographs were analyzed by two independent physicians in a blind fashion for evidence of radiographic fusion. RESULTS: At follow-up no discernible difference was noted for functional outcomes. Eighty-three percent of @entity1 in Group 1 and 90% of @entity1 in Group 2 noted excellent or good results. This was not statistically significant (p=.280). In Group 1, 97% of @entity1 returned to work at an average of 18 weeks, whereas 98% of @entity1 in Group 2 returned to work at an average of 10 weeks postoperatively. Upon radiographic evaluation, 64% of @entity1 in Group 1 were determined to have a solid fusion (Grade 3). The fusion rate in Group 2 was 72%. This was not statistically significant. However, the fusion rate among smokers was 50%, and among nonsmokers it was 80%. This was statistically significant (p=.001). CONCLUSIONS: Workman's compensation claims did not adversely affect the functional outcome of ACDF. It should be noted that a significant increase in @entity1516 was noted with the smoking population. @entity1 selection is a critical factor in determining functional outcome, with 83% good to excellent results if the pathology, clinical presentation and radiographic findings correlate
