Shin Dong Ah, Yi Seong, Yoon Do Heum, Kim Keung Nyun, Shin Hyun Cheol
Department of Neurosurgery, CHA University, College of Medicine, Seongnam, South Korea.
Spine (Phila Pa 1976). 2009 May 15;34(11):1153-9; discussion 1160-1. doi: 10.1097/BRS.0b013e31819c9d39.
A prospective analysis.
The purpose of this study was to compare the clinical and radiologic outcomes of cervical artificial disc replacement (C-ADR) combined with anterior cervical discectomy and fusion (ACDF) and 2-level ACDF in patients with 2-level cervical disc disease.
Adjacent segment degeneration is a long-term complication of ACDF, and estimated to affect 25% of patients within 10 years of the initial surgery. Two-level fusion leads to a substantially greater increase in intradiscal pressure than one-level fusion. It has been demonstrated that C-ADR maintains motion at the level of the surgical procedure and decreases strain on the adjacent segments for prevention of adjacent segment degeneration. In the case of 2-level cervical disc disease, hybrid surgery (HS), consisting of C-ADR combined with ACDF, may be a reasonable alternative to 2-level ACDF (2-ACDF).
Between 2004 and 2006, 40 patients undergoing 2-level cervical disc surgery at our hospital were identified who met the following surgical indications: 2 consecutive level degenerative disc disease between C3/4 and C6/7; either a radiculopathy or myelopathy; and no response to conservative treatment for >6 weeks. Twenty patients of the HS group were matched to 20 patients of the 2-ACDF group based on age and gender. Patients were asked to check the neck disability index (NDI) and grade their pain intensity before surgery and at routine postoperative intervals of 1, 3, 6, 12, and 24 months. Dynamic flexion and extension lateral cervical radiographs were obtained in the standing position before surgery and at routine postoperative intervals of 1, 3, 6, 12, and 24 months. The angular range of motion (ROM) for C2-C7 and adjacent segments were measured using the Cobb method with PACS software.
The HS group had better NDI recovery 1 and 2 years after surgery (P < 0.05). Postoperative neck pain was less in the HS group 1 month and 1 year after surgery (P < 0.05). There was no difference in arm pain relief between the groups. The HS group showed faster C2-C7 ROM recovery. The mean C2-C7 ROM of the HS group recovered to that of the preoperative value, but that of the 2-ACDF group did not (P < 0.05). The inferior adjacent segment ROM showed significant differences between the groups 6 and 9 months, and 1 and 2 years after surgery (P < 0.05, P < 0.01, P < 0.05, and P < 0.05, respectively).
HS is superior to 2-ACDF in terms of better NDI recovery, less postoperative neck pain, faster C2-C7 ROM recovery, and less adjacent ROM increase.
前瞻性分析。
本研究旨在比较颈椎人工椎间盘置换术（C-ADR）联合颈椎前路椎间盘切除融合术（ACDF）与两节段ACDF治疗两节段颈椎间盘疾病患者的临床和影像学结果。
相邻节段退变是ACDF的一种长期并发症，据估计在初次手术后10年内影响25%的患者。两节段融合导致椎间盘内压力的增加比单节段融合大得多。已经证明，C-ADR可维持手术节段的活动度，并减少相邻节段的应力以预防相邻节段退变。对于两节段颈椎间盘疾病，由C-ADR联合ACDF组成的混合手术（HS）可能是两节段ACDF（2-ACDF）的合理替代方案。
2004年至2006年期间，在我院接受两节段颈椎手术的40例患者被确定符合以下手术指征：C3/4至C6/7连续两个节段的退行性椎间盘疾病；神经根病或脊髓病；对保守治疗>6周无反应。根据年龄和性别，将HS组的20例患者与2-ACDF组的20例患者进行匹配。要求患者在手术前以及术后1、3、6、12和24个月的常规随访时检查颈部功能障碍指数（NDI）并对疼痛强度进行评分。在手术前以及术后1、3、6、12和24个月的常规随访时，于站立位获取颈椎动态屈伸侧位X线片。使用PACS软件通过Cobb法测量C2-C7及相邻节段的活动度（ROM）角度范围。
HS组在术后1年和2年NDI恢复情况更好（P<0.05）。HS组在术后1个月和1年颈部疼痛较轻（P<0.05）。两组间手臂疼痛缓解情况无差异。HS组C2-C7的ROM恢复更快。HS组C2-C7的平均ROM恢复到术前水平，但2-ACDF组未恢复到术前水平（P<0.05）。两组在术后6个月和9个月、1年和2年时，下位相邻节段的ROM存在显著差异（分别为P<0.05、P<0.01、P<0.05和P<0.05）。
在NDI恢复更好、术后颈部疼痛较轻、C2-C7的ROM恢复更快以及相邻节段ROM增加较少方面，HS优于2-ACDF。
