Goldberg Edward J, Singh Kern, Van U, Garretson Ralph, An Howard S
Department of Orthopedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, 1725 West Harrison Street, POB 1063, Chicago, IL 60661, USA.
Spine J. 2002 Nov-Dec;2(6):408-14. doi: 10.1016/s1529-9430(02)00441-2.
Anterior cervical discectomy and fusion (ACDF) is an accepted surgical procedure to treat degenerative conditions, including disc herniations and spinal stenosis. The literature on lumbar spine surgery reports that patients with a workman's compensation claim have less successful clinical results. Regarding the cervical spine, however, different conclusions have been drawn.
The purpose of this study was to directly compare the functional outcomes of ACDF in patients with and without a workman's compensation claim and to determine whether a compensation claim adversely affected the clinical outcome.
This is a retrospective study examining the long-term results of ACDF in the workman's and non-workman's compensation populations.
Eighty consecutive patients undergoing ACDF were retrospectively analyzed. The patients were divided into two groups: 30 patients in Group 1 (workman's compensation) and 50 patients in Group 2 (non-workman's compensation). The average age of Group 1 was 45 years (range, 31 to 57) and Group 2 was 45 years (range, 30 to 79). The patients were followed for an average length of 4 years (range, 2 to 7 years).
We evaluated the surgical results using a functional outcome scoring system (Odom's Criteria), visual analog scale and a radiographic grading scale. The questionnaire was independently administered in a standard question-answer format at the 1-year follow-up. Statistical analyses was performed using a Levene's test.
All surgeries were performed by the same attending physician. A left-sided approach and Smith-Robinson fusion technique with autograft or allograft without instrumentation was used in all cases. A hard cervical orthosis was used postoperatively for 8 weeks. Radiographic examination including lateral flexion and extension views were obtained at a minimum of 12 months postoperatively. Furthermore, radiographic analysis was performed each subsequent postoperative year. The radiographs were analyzed by two independent physicians in a blind fashion for evidence of radiographic fusion.
At follow-up no discernible difference was noted for functional outcomes. Eighty-three percent of patients in Group 1 and 90% of patients in Group 2 noted excellent or good results. This was not statistically significant (p=.280). In Group 1, 97% of patients returned to work at an average of 18 weeks, whereas 98% of patients in Group 2 returned to work at an average of 10 weeks postoperatively. Upon radiographic evaluation, 64% of patients in Group 1 were determined to have a solid fusion (Grade 3). The fusion rate in Group 2 was 72%. This was not statistically significant. However, the fusion rate among smokers was 50%, and among nonsmokers it was 80%. This was statistically significant (p=.001).
Workman's compensation claims did not adversely affect the functional outcome of ACDF. It should be noted that a significant increase in pseudarthroses was noted with the smoking population. Patient selection is a critical factor in determining functional outcome, with 83% good to excellent results if the pathology, clinical presentation and radiographic findings correlate
颈椎前路椎间盘切除融合术（ACDF）是治疗包括椎间盘突出和椎管狭窄在内的退行性疾病的一种公认的外科手术。关于腰椎手术的文献报道称，有工伤赔偿申请的患者临床效果不太理想。然而，对于颈椎手术，却得出了不同的结论。
本研究的目的是直接比较有和没有工伤赔偿申请的患者接受ACDF后的功能结局，并确定赔偿申请是否会对临床结局产生不利影响。
这是一项回顾性研究，旨在考察工伤赔偿人群和非工伤赔偿人群接受ACDF的长期结果。
对连续80例行ACDF的患者进行回顾性分析。患者分为两组：第1组（工伤赔偿组）30例患者，第2组（非工伤赔偿组）50例患者。第1组的平均年龄为45岁（范围31至57岁），第2组为45岁（范围30至79岁）。患者平均随访4年（范围2至7年）。
我们使用功能结局评分系统（奥多姆标准）、视觉模拟量表和影像学分级量表评估手术结果。在1年随访时，以标准问答形式独立发放问卷。使用Levene检验进行统计分析。
所有手术均由同一位主治医师进行。所有病例均采用左侧入路及Smith-Robinson融合技术，使用自体骨或异体骨，不使用内固定器械。术后使用硬质颈椎矫形器8周。术后至少12个月进行包括侧屈和后伸位片的影像学检查。此外，术后每年进行影像学分析。由两位独立的医生以盲法分析X线片以确定影像学融合的证据。
随访时，功能结局未发现明显差异。第1组83%的患者和第2组90%的患者结果为优或良。这无统计学意义（p = 0.280）。在第1组中，97%的患者平均在18周后重返工作岗位，而第2组98%的患者术后平均10周重返工作岗位。经影像学评估，第1组64%的患者被确定为有牢固融合（3级）。第2组的融合率为72%。这无统计学意义。然而，吸烟者的融合率为50%，非吸烟者为80%。这有统计学意义（p = 0.001）。
工伤赔偿申请并未对ACDF的功能结局产生不利影响。应当指出的是，吸烟人群假关节形成显著增加。患者选择是决定功能结局的关键因素，如果病理、临床表现和影像学表现相关，则83%的患者结果为良至优
