The effect of patient race on extent of functional improvement after cervical spine surgery

Study Design. A longitudinal cohort study. Objective. In this study, we set out to assess the association between racial differences and health outcomes after anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Although racial disparities in the use of surgical procedures are well established, relationships between race and patient-reported outcomes measures after ACDF have not been previously assessed. Methods. Sixty adult patients (black patients: 28, white patients: 32) undergoing ACDF at Duke University Medical Center were included in this study. Enrollment criteria included available demographic, surgical, and clinical outcome data. All patients had prospectively collected patient-reported outcomes measures and a minimum 1-year follow-up. Patients completed the Neck Disability Index (NDI), Short-Form 12 (SF-12), and Visual Analog Pain Scale (VAS) before surgery, and then at 3, 6, and 12 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts. Results. Baseline characteristics were similar between both cohorts. The median [interquartile range] number of levels fused was similar between both patient cohorts 2 [1-2], P=0.41. There was no significant difference between cohorts in the incidence of nerve root injury (P=0.99) or incidental durotomy (P=0.31). At 3 months postoperatively, both cohorts demonstrated similar improvement in VAS-neck pain (P=0.75), NDI (P=0.31), SF-12 physical component score (PCS) (P=0.82), and SF-12 mental component score (MCS) (P=0.43). These results were durable through 1 year. At 1 year, both the black and white patients demonstrated similar improvement from baseline in NDI (P =0.36), VAS neck pain (P =0.35), SF-12 PCS (P=0.18), and SF-12 MCS (P=0.56). Conclusion. Our study suggests that at 1 year, there were no substantial differences in between races in patient-reported outcomes measures after ACDF. Both black and white patients expressed similar improvement from baseline in all outcomes metrics.