颈椎排列恢复与单节段和双节段颈椎前路椎间盘切除融合术后临床疗效改善相关。
Restoration of Cervical Alignment is Associated with Improved Clinical Outcome after One and Two Level Anterior Cervical Discectomy and Fusion.
作者信息
Hu Xiaobang, Ohnmeiss Donna D, Zigler Jack E, Guyer Richard D, Lieberman Isador H
机构信息
Scoliosis and Spine Tumor Program, Texas Back Institute, Texas Health Presbyterian Hospital Plano, Plano, TX.
Texas Back Institute Research Foundation, Plano, TX.
出版信息
Int J Spine Surg. 2015 Nov 12;9:61. doi: 10.14444/2061. eCollection 2015.
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) remains the standard of care for patients with cervical radiculopathy who are unresponsive to conservative care. However, the maintenance and restoration of cervical alignment as a predictive factor for outcome has not yet been fully evaluated. The purpose of this study was to evaluate the impact of maintaining or restoring cervical alignment on one and two level ACDF patients' outcome.
METHODS
Data were collected from 104 patients who underwent one and two level ACDF. Cervical alignment was measured preoperatively and at follow-up visits. The patients were classified into three groups based on the postoperative change of their cervical alignment. Neck pain, arm pain, and Neck Disability Index (NDI) scores were obtained preoperatively and at the latest follow-up visit. Incidences of adjacent segment degeneration (ASD) and reoperations because of ASD were recorded.
RESULTS
There were 64 patients in the Maintained group, 17 patients in the Restored group and 23 patients in the Kyphotic group. Pre-operatively, the neck pain scores, arm pain scores and NDI scores were not statistically different among the three groups (p>0.05). On average at 12 months follow-up, the neck pain scores improved by 2.7, 4.2, and 2.7 points respectively in the three groups (p>0.05). The patients' arm pain scores improved by 2.1, 2.4, and 2.8 points respectively (p>0.05). NDI scores improved by 12, 31 and 13.7 points respectively (p<0.05). The incidences of ASD and reoperations because of ASD were 16%, 12% and 35% respectively (p>0.05).
CONCLUSIONS
The patients with restored cervical alignment had significantly greater NDI improvement and relatively better neck pain improvement. There was a trend for patients who had unchanged cervical kyphosis to have a higher incidence of ASD. Our study suggests that restoration of cervical alignment will contribute to improved clinical outcome in the patients who have one and two level ACDF surgeries.
LEVEL OF EVIDENCE
This is a level III study.
背景
对于保守治疗无效的神经根型颈椎病患者，颈椎前路椎间盘切除融合术（ACDF）仍是标准治疗方法。然而，颈椎对线的维持和恢复作为预后的预测因素尚未得到充分评估。本研究的目的是评估维持或恢复颈椎对线对单节段和双节段ACDF患者预后的影响。
方法
收集104例行单节段和双节段ACDF患者的数据。术前及随访时测量颈椎对线情况。根据术后颈椎对线的变化将患者分为三组。术前及最新随访时获取颈部疼痛、手臂疼痛和颈部功能障碍指数（NDI）评分。记录相邻节段退变（ASD）的发生率及因ASD进行再次手术的情况。
结果
维持组64例，恢复组17例，后凸组23例。术前，三组间颈部疼痛评分、手臂疼痛评分和NDI评分无统计学差异（p>0.05）。平均随访12个月时，三组颈部疼痛评分分别改善2.7、4.2和2.7分（p>0.05）。患者手臂疼痛评分分别改善2.1、2.4和2.8分（p>0.05）。NDI评分分别改善12、31和13.7分（p<0.05）。ASD及因ASD再次手术的发生率分别为16%、12%和35%（p>0.05）。
结论
颈椎对线恢复的患者NDI改善明显更大，颈部疼痛改善相对更好。颈椎后凸无变化的患者ASD发生率有升高趋势。我们的研究表明，颈椎对线的恢复将有助于改善接受单节段和双节段ACDF手术患者的临床预后。
证据水平
这是一项III级研究。
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