Does Cervical Spondylolisthesis Influence Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion Surgery?

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Radiographic interpretation and diagnosis of cervical spondylolisthesis. Cervical spondylolisthesis was diagnosed by a group of 10 fellowship-trained, orthopedic spine surgeons by interpreting a discontinuity in the posterior vertebral line (from C2-T1) on standing, lateral x-rays obtained at preoperative office encounters. (A) Preoperative, lateral film demonstrating discontinuity of posterior vertebral line between C5 and C6. (B) Postoperative, lateral film after single-level anterior cervical discectomy and fusion.

Table

Patient-reported outcome measurements between cervical spondylolisthesis groups.

Tool	Outcome Measure	Outcome Score, mean (95% CI)		Univariate Analysis	Multiple Linear Regression, β (95% CI), P value
Tool	Outcome Measure	No Spondylolisthesis (n = 154)	Spondylolisthesis (n = 54)	Univariate Analysis	Multiple Linear Regression, β (95% CI), P value
NDI	Pre	37.0 (33.0, 41.0)	42.0 (35.0, 50.0)	0.210	−4.928 (−15.271, 5.415), 0.344
	Post	29.7 (24.7, 34.7)	25.7 (18.9, 32.5)	0.377
	Delta	−7.1 (−13.7, −0.6)	−13.6 (−23.0, −4.2)	0.264
	Paired samples t test	0.033^a	0.007^a	-
PCS-12	Pre	35.0 (33.5, 36.5)	34.1 (31.2, 37.0)	0.568	1.990 (−1.674, 5.655), 0.285
	Post	37.8 (36.0, 39.6)	39.3 (36.2, 42.4)	0.544
	Delta	2.8 (0.9, 4.8)	5.2 (1.4, 9.0)	0.239
	Paired samples t test	0.005^a	0.008^a	-
MCS-12	Pre	48.0 (45.9, 50.0)	44.1 (40.3, 47.9)	0.044a	4.841 (0.876, 8.805), 0.017^a
	Post	49.3 (47.3, 51.2)	52.4 (49.4, 55.5)	0.102
	Delta	1.3 (−1.0, 3.6)	8.3 (3.8, 12.9)	0.010a
	Paired samples t test	0.258	0.001^a	-
VAS Neck	Pre	5.6 (5.1, 6.0)	6.3 (5.4, 7.2)	0.116	−1.077 (−2.568, 0.415), 0.154
	Post	3.5 (2.8, 4.1)	2.9 (1.9, 3.9)	0.377
	Delta	−2.1 (−3.0, −1.1)	−3.3 (−4.9, −1.7)	0.277
	Paired samples t test	<0.001^a	<0.001^a	-
VAS Arm	Pre	5.5 (5.0, 6.1)	6.2 (5.2, 7.2)	0.136	−1.206 (−2.954, 0.542), 0.172
	Post	3.1 (2.3, 3.9)	3.0 (1.6, 4.4)	0.740
	Delta	−2.4 (−3.6, −1.3)	−3.5 (−5.6, −1.4)	0.255
	Paired samples t test	<0.001^a	0.003^a	-

Note: Univariate analysis: Mann-Whitney U, Pearson’s χ², or Fisher’s Exact test.
Note: Multiple Linear Regression analysis conducted to predict whether presence of spondylolisthesis prior to surgery was a significant predictor of change in outcomes over time—controlling for factors including age, sex, BMI, smoking status, and baseline scores.
aIndicates significance (P < 0.05)
MCS-12, Mental Component Scores of the Short Form-12; NDI, Neck Disability Index; PCS-12, Physical Component Scores of the Short Form-12; VAS, visual analog scale.