Department of Neurosurgery, Spine Center, Schulthess Clinic, Zürich, Switzerland.
Neurosurg Focus. 2013 Jul;35(1):E4. doi: 10.3171/2013.3.FOCUS1396.
Both anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) are used to treat cervical spondylotic myelopathy; however, there is currently no evidence for the superiority of one over the other in terms of patient-rated outcomes. This comparative effectiveness study compared the patient-rated and radiographic outcomes of 2-level ACDF versus 1-level ACCF.
This single-center study was nested within the EuroSpine Spine Tango data acquisition system. Inclusion criteria were the following: consecutive patients presenting with signs of cervical spondylotic myelopathy who underwent 2-level ACDF or 1-level ACCF between 2004 and 2011. Before and 12 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI) and also rated global treatment outcome and satisfaction with care on 5-point Likert scales. Cervical lordosis, segmental height, and fusion rate were assessed radiographically before and immediately after surgery and at the last follow-up (20.4 ± 13.7 months, mean ± SD).
In total, 118 consecutive patients (80 in the ACDF group and 38 in the ACCF group) were included. Age, sex, comorbidity, baseline symptoms, baseline radiographic data, operation duration, and complication rates did not differ significantly between the 2 groups. Blood loss was significantly (p < 0.04) lower in the ACDF group. Postoperative mean segmental height was significantly (p = 0.0006) greater for ACDF (42.0 ± 4.2 mm, mean ± SD) than for ACCF (39.0 ± 4.0 mm), and global average lordosis improved to a significantly (p = 0.003) greater extent in ACDF (by 1.6° ± 4.1°) than in ACCF (by -1.0° ± 4.0°). Fusion rates for ACDF were 97.5% and for ACCF were 94.7% (p = 0.59). The 12-month patient-rated outcomes did not differ significantly between ACDF and ACCF: 82.4% and 68.6% had a good global outcome (operation helped/helped a lot) (p = 0.10), 86.5% and 82.9% were satisfied/very satisfied with care (p = 0.62), and the reduction in the multidimensional COMI was 2.8 ± 2.7 and 2.2 ± 3 points (p = 0.30), respectively. The postoperative increase in lordosis angle showed low but significant correlations with the improvement in arm pain (r = 0.25, p = 0.014), highest pain (r = 0.25, p = 0.013), and function (r = 0.24, p = 0.016).
Both ACDF and ACCF are safe and effective in the treatment of cervical spondylotic myelopathy, indicated by similarly good patient-rated outcomes 1 year after surgery. This precludes any conclusions regarding the superiority of one technique over the other, although it should be noted that ACDF resulted in less blood loss and greater improvements in cervical lordosis and segmental height than ACCF. Patients with improved lordosis angle had a better clinical outcome.
颈椎前路椎间盘切除术融合术（ACDF）和颈椎前路椎体切除术融合术（ACCF）均用于治疗脊髓型颈椎病；然而，目前尚无证据表明这两种方法在患者评定结果方面哪一种更具优势。本项比较有效性研究比较了 2 节段 ACDF 与 1 节段 ACCF 的患者评定结果和影像学结果。
这项单中心研究嵌套在 EuroSpine Spine Tango 数据采集系统中。纳入标准为：2004 年至 2011 年间连续出现脊髓型颈椎病症状并接受 2 节段 ACDF 或 1 节段 ACCF 治疗的患者。手术前后 12 个月，患者完成多维核心结局测量指标（COMI），并在 5 分制量表上评定整体治疗效果和对护理的满意度。在手术前后以及最后一次随访（20.4 ± 13.7 个月，均值 ± 标准差）时评估颈椎前凸角、节段高度和融合率。
共纳入 118 例连续患者（ACDF 组 80 例，ACCF 组 38 例）。2 组间的年龄、性别、合并症、基线症状、基线影像学数据、手术时间和并发症发生率无显著差异。ACDF 组的失血量显著（p < 0.04）低于 ACCF 组。术后平均节段高度 ACDF 组（42.0 ± 4.2mm，均值 ± 标准差）显著大于 ACCF 组（39.0 ± 4.0mm）（p = 0.0006），ACDF 组的整体平均前凸角显著（p = 0.003）增加了 1.6° ± 4.1°，而 ACCF 组仅增加了 -1.0° ± 4.0°。ACDF 的融合率为 97.5%，ACCF 为 94.7%（p = 0.59）。ACDF 和 ACCF 组的 12 个月患者评定结果无显著差异：82.4%和 68.6%的患者有良好的整体治疗效果（手术有帮助/帮助很大）（p = 0.10），86.5%和 82.9%的患者对护理满意/非常满意（p = 0.62），多维 COMI 分别降低了 2.8 ± 2.7 分和 2.2 ± 3 分（p = 0.30）。术后前凸角的增加与手臂疼痛（r = 0.25，p = 0.014）、最高疼痛（r = 0.25，p = 0.013）和功能（r = 0.24，p = 0.016）的改善呈低度但显著相关。
ACDF 和 ACCF 在治疗脊髓型颈椎病方面均安全有效，术后 1 年患者评定结果相似。这排除了任何一种技术优于另一种技术的结论，尽管应该注意到 ACDF 导致的失血量更少，颈椎前凸角和节段高度的改善程度更大。前凸角改善的患者有更好的临床结果。
