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Upper Cervical Anterior Diskectomy and Fusion Improves Discogenic Cervical Headaches

Schofferman, Jerome, MD*; Garges, Kim, MD; Goldthwaite, Noel, MD; Koestler, Mary, RN, MSN, CCRC; Libby, Erin, BS

Cervical Spine

Study Design. Retrospective patient identification and prospective data collection were performed.

Objective. To evaluate the outcome of anterior cervical diskectomy and fusion for discogenic cervical headaches.

Summary of Background Data. Cervicogenic headaches affect up to 2.5% of the population. One cause is discogenic pain. Because anterior cervical diskectomy and fusion may improve neck pain, the effect of this procedure on discogenic cervical headaches was evaluated.

Methods. Nine patients with severe refractory cervicogenic headaches who underwent anterior cervical diskectomy and fusion of the upper cervical discs were retrospectively identified on the basis of clinical, radiographic, and diskography findings. Pain was measured by a numerical rating scale, and function by the Oswestry Disability Index.

Results. The study involved six women and three men with a mean age of 52 (range, 35–72 years) and a mean follow-up period of 37 months (range, 24–49 months). Anterior cervical diskectomy and fusion was performed at both C2–C3 and C3–C4 in seven patients, at C2–C3 in one patient, and at C2–C3, C3–C4, and C4–C5 in one patient. Associated symptoms included nausea, arm pain, dizziness, and visual disturbances. All the patients improved. All stated that they would have the same surgery again for the same outcome. The mean numerical rating score improved from 8 (range, 5–10) to 2.7 (range, 0–7) (P < 0.001), and five patients (56%) had total headache relief. The mean Oswestry Disability Index improved from 62 (range, 42–87) to 35 (range, 2–82) (P < 0.009). The associated symptoms resolved in all the patients. There was early moderate to severe dysphagia in three patients, and mild dysphagia in four patients. At the final follow-up assessment, five patients evidenced mild dysphagia.

Conclusions Anterior cervical diskectomy and fusion appears to be quite effective for discogenic cervical headache, but should be reserved for patients who are extremely impaired and refractory to all other treatments.

From the *SpineCare Medical Group and The San Francisco Spine Institute, Daly City, California,

the †Department of Orthopaedics and Rehabilitation, University of Texas Medical Branch at Galveston, Texas.

Acknowledgment date: October 11, 2001.

First revision date: January 24, 2002.

Acceptance date: April 22, 2002.

Address reprint requests to

Jerome Schofferman, MD

1850 Sullivan Avenue

Daly City, CA 94015

Device status/drug statement: The submitted manuscript does not contain information about medical devices or drugs.

Conflict of interest: No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2002 Lippincott Williams & Wilkins, Inc.