Tracey Robert W, Kang Daniel G, Cody John P, Wagner Scott C, Rosner Michael K, Lehman Ronald A
Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, USA.
Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, USA.
J Clin Neurosci. 2014 Nov;21(11):1905-8. doi: 10.1016/j.jocn.2014.05.007. Epub 2014 Jun 28.
Several studies have established the short-term safety and efficacy of cervical disc arthroplasty (CDA) as compared to anterior cervical discectomy and fusion (ACDF). However, few single-center comparative trials have been performed, and current studies do not contain large numbers of patients. We retrospectively reviewed all patients from a single military tertiary medical center between August 2008 to August 2012 who underwent single-level CDA or single-level ACDF and compared their clinical outcomes and complications. A total of 259 consecutive patients were included in the study, 171 patients in the CDA group with an average follow-up of 9.8 (±9.9)months and 88 patients in the ACDF group with an average follow-up of 11.8 (±9.6)months. Relief of pre-operative symptoms was 90.1% in the CDA group and 86.4% in the ACDF group with rates of return to full pre-operative activity of 93.0% and 88.6%, respectively. Patients who underwent CDA had a higher rate of persistent posterior neck pain (15.8% versus 12.5%), and patients who underwent ACDF were at risk for symptomatic pseudarthrosis at a rate of 3.4%. Reoperation rates were higher in the ACDF group (5.7% versus 3.5%). To our knowledge, this review is the largest, non-funded, comparison study between single-level CDA and single-level ACDF. This study demonstrates that CDA is a safe and reliable alternative to ACDF in the treatment of cervical radiculopathy and myelopathy resulting from spondylosis and acute disc herniation.
与颈椎前路椎间盘切除融合术（ACDF）相比，多项研究已证实颈椎间盘置换术（CDA）的短期安全性和有效性。然而，很少有单中心对照试验，且目前的研究纳入患者数量不多。我们回顾性分析了2008年8月至2012年8月期间在一家军队三级医疗中心接受单节段CDA或单节段ACDF的所有患者，并比较了他们的临床结局和并发症。该研究共纳入259例连续患者，CDA组171例，平均随访9.8（±9.9）个月；ACDF组88例，平均随访11.8（±9.6）个月。CDA组术前症状缓解率为90.1%，ACDF组为86.4%，恢复至术前全部活动水平的比例分别为93.0%和88.6%。接受CDA的患者持续性颈后疼痛发生率较高（15.8%对12.5%），接受ACDF的患者症状性假关节形成风险率为3.4%。ACDF组再次手术率更高（5.7%对3.5%）。据我们所知，本综述是单节段CDA与单节段ACDF之间规模最大的非资助对照研究。本研究表明，在治疗颈椎病和急性椎间盘突出症所致的神经根型颈椎病和脊髓病方面，CDA是ACDF的一种安全可靠的替代方法。
