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The Effect of an Anterior Cervical Operation for Cervical Radiculopathy or Myelopathy on Associated Headaches

¹ Orthopaedics Indianapolis, 8450 Northwest Boulevard, Indianapolis, IN 46278
² Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin, 600 Highland Avenue K4/736, Madison, WI 53792
³ Departments of Neurosurgery and Orthopaedics, 74-144CHS, David Geffen School of Medicine, University of California at Los Angeles, 10833 LeConte Avenue, Los Angeles, CA 90095
⁴ Research Department, Center for Hip and Knee Surgery, St. Francis Hospital, 1199 Hadley Road, Mooresville, IN 46158-1788
⁵ Washington University Orthopaedics, 660 South Euclid Avenue, CB-8233, St. Louis, MO 63110

Investigation performed at OrthoIndy, Indianapolis, Indiana

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Medtronic). Also, commercial entities (Medtronic and Orthopaedic Research Foundation) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Methods: We conducted a post hoc analysis of study cohorts combined from prospective studies comparing the results of Prestige and Bryan cervical arthroplasty devices and those of anterior cervical arthrodesis with allograft and anterior instrumentation. A total of 1004 patients (51.6% were male) were evaluated with use of the Neck Disability Index questionnaire preoperatively and at five points postoperatively, with the latest evaluation at twenty-four months, resulting in a follow-up of 803 patients.

Results: At the twenty-four-month follow-up, the improvement from baseline with regard to headache was significant in both groups (p < 0.0001), with patients who underwent arthroplasty reporting numerically better pain scores. Most arthroplasty and arthrodesis patients (64% and 58.5%, respectively) had improvement in the pain score of at least one grade. Conversely, the pain scores for 8.4% of those who had an arthroplasty and 13.7% of those who had arthrodesis worsened by at least one grade. For the remainder, the score was unchanged. Overall, the patients who had an arthroplasty had significant improvement more frequently than did the patients who had arthrodesis (p = 0.011).

Conclusions: At two years postoperatively, patients undergoing anterior cervical operations, both those who have an arthroplasty and those who have an arthrodesis, for cervical radiculopathy and myelopathy can be expected to have significant improvement from baseline with regard to headache symptoms.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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