颈椎间盘置换与单节段融合治疗颈椎疾病的邻近节段病的发生率：前瞻性研究的荟萃分析。

Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion: meta-analysis of prospective studies.

机构信息

*Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA; and †Drexel University College of Medicine, Philadelphia, PA.

出版信息

Spine (Phila Pa 1976). 2013 Dec 15;38(26):2253-7. doi: 10.1097/BRS.0000000000000052.

DOI:10.1097/BRS.0000000000000052

PMID:24335631

Abstract

STUDY DESIGN

Meta-analysis of randomized controlled trials.

OBJECTIVE

To compare the reported incidence of adjacent segment disease (ASD) requiring surgical intervention between anterior cervical decompression and fusion (ACDF) and total disc arthroplasty (TDA).

SUMMARY OF BACKGROUND DATA

The concern for ASD has led to the development of motion-preserving technologies such as TDA. To date, however, no known study has sought to compare the incidence of ASD between ACDF and TDA in major prospective studies.

METHODS

A systematic review of IDE and non-IDE trials was performed using PubMed and Cochrane libraries. These databases were thoroughly searched for prospective randomized studies comparing ACDF and TDR. Six studies met the inclusion criteria for a meta-analysis and were used to report an overall rate of ASD for both ACDF and TDA.

RESULTS

Pooling data from 6 prospective studies, the overall sample size at baseline was 1586 (ACDF = 777, TDA = 809) and at the final follow-up was 1110 giving an overall follow-up of 70%. Patients after an ACDF had a lower rate of follow-up overall than those after TDR (ACDF: 67.3% vs. TDR: 72.6%, P= 0.01). Thirty-six patients required adjacent-level surgery after an ACDF at 2 to 5 years of follow-up (6.9%) compared with 30 patients after a TDA (5.1%). The corresponding reoperation rate for ASD was 2.4 ± 1.7% per year for ACDF versus 1.1 ± 1.5% per year for TDR. These differences were not statistically significant (P= 0.44). Using a Kaplan-Meier analysis and historical data, we expect 48 patients in the ACDF group and 55 patients in the TDR group to have symptomatic disease at an adjacent level.

CONCLUSION

From a meta-analysis of prospective studies, there is no difference in the rate of ASD for ACDF versus TDA. We also report an overall lower rate of follow-up for patients with ACDF than for those with TDR. Future prospective studies should continue to focus on excellent patient follow-up and accurate assessment of patient symptoms that are attributable to an adjacent level as this has been an under-reported finding in prospective studies.

LEVEL OF EVIDENCE

摘要

研究设计

随机对照试验的荟萃分析。

目的

比较前路颈椎减压融合术（ACDF）和全椎间盘置换术（TDA）治疗后报告的需要手术干预的邻近节段疾病（ASD）发生率。

背景资料概述

对 ASD 的担忧导致了诸如 TDA 等保留运动技术的发展。然而，迄今为止，尚无已知研究试图在主要的前瞻性研究中比较 ACDF 和 TDA 之间 ASD 的发生率。

方法

使用 PubMed 和 Cochrane 数据库对 IDE 和非 IDE 试验进行系统评价。彻底搜索这些数据库，以寻找比较 ACDF 和 TDR 的前瞻性随机研究。符合荟萃分析纳入标准的 6 项研究用于报告 ACDF 和 TDA 的 ASD 总体发生率。

结果

汇总 6 项前瞻性研究的数据，基线时的总样本量为 1586 例（ACDF=777 例，TDR=809 例），最终随访时为 1110 例，总随访时间为 70%。接受 ACDF 的患者总体随访率低于接受 TDR 的患者（ACDF：67.3%比 TDR：72.6%，P=0.01）。在 2 至 5 年的随访中，有 36 例 ACDF 患者需要进行邻近节段手术（6.9%），而 30 例 TDA 患者需要进行邻近节段手术（5.1%）。ASD 的相应再次手术率为 ACDF 每年 2.4±1.7%，TDR 每年 1.1±1.5%。这些差异无统计学意义（P=0.44）。使用 Kaplan-Meier 分析和历史数据，我们预计 ACDF 组有 48 例患者和 TDR 组有 55 例患者在邻近节段出现症状性疾病。