Does Symptom Duration Prior to Anterior Cervical Discectomy and Fusion for Disc Herniation Influence Patient-Reported Outcomes in a Workers' Compensation Population?

-OBJECTIVE: To evaluate the influence of symptom dura-tion before anterior cervical discectomy and fusion (ACDF) on patient-reported outcomes (PROs) in workers' compen-sation patients.-METHODS: A prospective registry was searched for workers' compensation patients who underwent ACDF for herniated disc. Two cohorts based on symptom duration were formed: lesser duration (LD) (<6 months) and pro-longed duration (PD) (double dagger 6 months). PROs were collected preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. PROs were compared within and between groups. Rates of minimum clinically important difference (MCID) were compared between groups.-RESULTS: The study included 63 patients. The LD cohort reported improvement in Patient-Reported Outcomes Measurement Information System -Physical Function (PROMIS-PF), Neck Disability Index (NDI), and visual analog scale (VAS) neck at 12 weeks and 6 months and VAS arm at all periods (all P 5 0.036). The LD cohort re-ported improvement in NDI at 12 weeks and 6 months and VAS arm at 6 weeks, 12 weeks, and 6 months (all P 5 0.037). Between groups, the LD cohort demonstrated superior scores in PROMIS-PF at 6 weeks, 12 weeks, and 6 months; NDI preoperatively and at 6 weeks, 12 weeks, and 6 months; VAS neck at 12 weeks; and 9-item Patient Health Questionnaire (PHQ-9) at 6 months (all P 5 0.045). The LD group was more likely to achieve MCID in PROMIS-PF at 12 weeks (P = 0.012). The PD group was more likely to achieve MCID in PHQ-9 at 6 months (P = 0.023).-CONCLUSIONS: Regardless of length of symptom dura-tion before ACDF in workers' compensation patients, the patients demonstrated improvements in disability and arm pain. Patients with LD also demonstrated improvements in physical function and neck pain. Patients with LD demon-strated superior scores in physical function, pain, disability, and mental health and were more likely to achieve clinically significant improvement in physical function. Patients with PD were more likely to achieve clinically significant improvement in mental health.