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The Effect of an Anterior Cervical Operation for Cervical Radiculopathy or Myelopathy on Associated Headaches
Joseph Riina, MD1; Paul A. Anderson, MD2; Langston T. Holly, MD3; Kathy Flint, RN, CNOR1; Kenneth E. Davis, MS4; K. Daniel Riew, MD5
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
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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.
Investigation performed at OrthoIndy, Indianapolis, Indiana

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Aug 01;91(8):1919-1923. doi: 10.2106/JBJS.H.00500
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Background: Headaches related to the cervical spine have been reported by various authors, and modalities of treatment are as varied as their speculated causes. The purpose of this study was to determine if anterior cervical reconstructive surgery (cervical arthrodesis and disc arthroplasty) for the treatment of radiculopathy or myelopathy also helps to alleviate associated headaches.

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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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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