Caruso R, Pesce A, Marrocco L, Wierzbicki V
Sapienza University of Rome, Department of Neurology and Psychiatry; Rome Army Medical Center, U.O.C. di Neurochirurgia; Sapienza University of Rome, Department of Neurosciences, Rome, Italy.
Sapienza University of Rome, Department of Neurology and Psychiatry.
Clin Ter. 2014;165(4):e263-70. doi: 10.7417/CT.2014.1741.
Many surgical techniques are used for the treatment of cervical myelopathy and radiculopathy due to spondylosis or disc herniation. The aim of this article is to evaluate and to compare the long term outcomes of 1. anterior cervical discectomy (ACD), 2. anterior cervical discectomy with fusion (ACDF) and 3. anterior cervical discectomy with total disc replacement (TDR) in order to find the most appropriate surgical option according to the medical condition of the patient.
Three retrospective cohort studies were performed to assess the long-term results of ACD, ACDF and TDR procedures. Data from the three studies were compared by statistical methods to highlight the differences in results.
All patients presented a neurological improvement that endures. The results of three surgical techniques were different as regards the alignment of the cervical spine, the preservation of mobility and the pathology of adjacent space.
TDR is the most appropriate technique in young patients, below the age of 55 years and whose pathology is prevalently a hernia. The best surgical choice is ACDF in patients above the age of 55 years and in all those cases in which there is a prevalence of spondyloarthrotic alterations. In highly selected cases, in which the cervical spine is in a flattened condition and the intervertebral space is very restricted ACD, according to Hirsh, is a surgical method which ensures a very high degree of spinal motility preservation.
许多外科技术被用于治疗因颈椎病或椎间盘突出症导致的脊髓型颈椎病和神经根型颈椎病。本文旨在评估和比较1. 颈椎前路椎间盘切除术（ACD）、2. 颈椎前路椎间盘切除融合术（ACDF）和3. 颈椎前路椎间盘全置换术（TDR）的长期疗效，以便根据患者的病情找到最合适的手术方案。
进行了三项回顾性队列研究，以评估ACD、ACDF和TDR手术的长期结果。通过统计方法对三项研究的数据进行比较，以突出结果的差异。
所有患者的神经功能均有持续改善。三种手术技术在颈椎排列、活动度保留和相邻节段病变方面的结果有所不同。
TDR是55岁以下且主要病变为椎间盘突出的年轻患者最合适的技术。对于55岁以上的患者以及所有以脊椎关节病变为主的病例，最佳手术选择是ACDF。在高度选择的病例中，即颈椎变平且椎间隙非常狭窄的情况下，根据赫什的观点，ACD是一种能确保高度保留脊柱活动度的手术方法。
