Steinberg Jeffrey A, German John W
Division of Neurosurgery, Albany Medical Center, Albany, NY.
Int J Spine Surg. 2012 Dec 1;6:55-61. doi: 10.1016/j.ijsp.2011.11.003. eCollection 2012.
The choice of surgical approach to the cervical spine may have an influence on patient outcome, particularly with respect to future neck pain and disability. Some surgeons suggest that patients with myelopathy or radiculopathy and significant axial pain should be treated with an anterior interbody fusion because a posterior decompression alone may exacerbate the patients' neck pain. To date, the effect of a minimally invasive posterior cervical decompression approach (miPCD) on neck pain has not been compared with that of an anterior cervical diskectomy or corpectomy with interbody fusion (ACF).
A retrospective review was undertaken of 63 patients undergoing either an miPCD (n = 35) or ACF (n = 28) for treatment of myelopathy or radiculopathy who had achieved a minimum of 6 months' follow-up. Clinical outcomes were assessed by a patient-derived neck visual analog scale (VAS) score and the neck disability index (NDI). Outcomes were analyzed by use of (1) a threshold in which outcomes were classified as success (NDI < 40, VAS score < 4.0) or failure (NDI > 40, VAS score > 4.0) and (2) perioperative change in which outcomes were classified as success (ΔNDI ≥ - 15, ΔVAS score ≥ - 2.0) or failure (ΔNDI < - 15, ΔVAS score < -2.0). Groups were compared by use of χ (2) tests with significance taken at P < .05.
At last follow-up, the percentages of patients classified as successful using the perioperative change criteria were as follows: 42% for miPCD group versus 63% for ACF group based on neck VAS score (P = not significant [NS]) and 33% for miPCD group versus 50% for ACF group based on NDI (P < .05). At last follow-up, the percentages of patients classified as successful using the threshold criteria were as follows: 71% for miPCD group versus 82% for ACF group based on neck VAS score (P = NS) and 69% for miPCD group versus 68% for ACF group based on NDI (P = NS).
In this small retrospective analysis, miPCD was associated with similar neck pain and disability to ACF. Given the avoidance of cervical instrumentation and interbody fusion in the miPCD group, these results suggest that further comparative effectiveness study is warranted.
颈椎手术入路的选择可能会对患者的预后产生影响，尤其是在未来颈部疼痛和功能障碍方面。一些外科医生认为，患有脊髓病或神经根病且伴有严重轴性疼痛的患者应采用前路椎体间融合术治疗，因为单纯后路减压可能会加重患者的颈部疼痛。迄今为止，微创后路颈椎减压术（miPCD）对颈部疼痛的影响尚未与颈椎前路椎间盘切除术或椎体次全切除术加椎体间融合术（ACF）进行比较。
对63例因脊髓病或神经根病接受miPCD（n = 35）或ACF（n = 28）治疗且至少随访6个月的患者进行回顾性研究。通过患者自评的颈部视觉模拟量表（VAS）评分和颈部功能障碍指数（NDI）评估临床疗效。采用以下两种方法分析结果：（1）设定一个阈值，将结果分为成功（NDI < 40，VAS评分 < 4.0）或失败（NDI > 40，VAS评分 > 4.0）；（2）围手术期变化，将结果分为成功（ΔNDI≥ - 15，ΔVAS评分≥ - 2.0）或失败（ΔNDI < - 15，ΔVAS评分 < -2.0）。采用χ²检验对两组进行比较，P <.05为有统计学意义。
在最后一次随访时，根据围手术期变化标准分类为成功的患者百分比如下：基于颈部VAS评分，miPCD组为42%，ACF组为63%（P = 无统计学意义[NS]）；基于NDI，miPCD组为33%，ACF组为50%（P <.05）。在最后一次随访时，根据阈值标准分类为成功的患者百分比如下：基于颈部VAS评分，miPCD组为71%，ACF组为82%（P = NS）；基于NDI，miPCD组为69%，ACF组为68%（P = NS）。
在这项小型回顾性分析中，miPCD与ACF在颈部疼痛和功能障碍方面相似。鉴于miPCD组避免了颈椎内固定和椎体间融合，这些结果表明有必要进行进一步的比较有效性研究。
