前路颈椎间盘切除融合术后颈部和手臂疼痛的改善
Improvements in Neck and Arm Pain Following an Anterior Cervical Discectomy and Fusion.
作者信息
Massel Dustin H, Mayo Benjamin C, Bohl Daniel D, Narain Ankur S, Hijji Fady Y, Fineberg Steven J, Louie Philip K, Basques Bryce A, Long William W, Modi Krishna D, Singh Kern
机构信息
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Department of Orthopaedic Surgery, New York Medical College, Valhalla, NY.
出版信息
Spine (Phila Pa 1976). 2017 Jul 15;42(14):E825-E832. doi: 10.1097/BRS.0000000000001979.
STUDY DESIGN
A retrospective analysis.
OBJECTIVE
The aim of this study was to quantify improvements in Visual Analogue Scale (VAS) neck and arm pain, Neck Disability Index (NDI), and Short Form-12 (SF-12) Mental (MCS) and Physical (PCS) Composite scores following an anterior cervical discectomy and fusion (ACDF).
SUMMARY OF BACKGROUND DATA
ACDF is evaluated with patient-reported outcomes. However, the extent to which these outcomes improve following ACDF remains poorly defined.
METHODS
A surgical registry of patients who underwent primary, one- or two-level ACDF during 2013 to 2015 was reviewed. Comparisons of VAS neck and arm, NDI, and SF-12 MCS and PCS scores were performed using paired t tests from preoperative to each postoperative time point. Analysis of variance (ANOVA) was used to estimate the reduction in neck and arm pain over the first postoperative year. Subgroup analyses were performed for patients with predominant neck (pNP) or arm (pAP) pain, as well as for one- versus two-level ACDF.
RESULTS
Eighty-nine patients were identified. VAS neck and arm, NDI, and SF-12 PCS improved from preoperative scores at all postoperative time points (P < 0.05 for each). Across the first postoperative year, patients reported a 2.7-point (44.2%) reduction in neck and a 3.1-point (54.0%) reduction in arm pain (P < 0.05 for each). Sixty-one patients with pNP and 28 patients with pAP reported reductions in neck and arm pain over the first 6 months and 12 weeks postoperatively, respectively (P < 0.05 for each). Patients who underwent one-level ACDFs experienced a 47.2% reduction in neck pain and 55.1% reduction in arm pain over the first postoperative year (P < 0.05 for each), while those undergoing two-level ACDF experienced 39.7% and 49.2% for neck and arm, respectively (P < 0.05 for each).
CONCLUSION
This study suggests that patients experience significant improvements in neck and arm pain following ACDF regardless of presenting symptom. In addition, patients undergoing one-level ACDF report greater reductions in neck and arm pain than patients undergoing two-level fusion.
LEVEL OF EVIDENCE
研究设计
回顾性分析。
目的
本研究旨在量化前路颈椎间盘切除融合术（ACDF）后视觉模拟量表（VAS）颈部和手臂疼痛、颈部功能障碍指数（NDI）以及简明健康调查问卷12项（SF - 12）心理（MCS）和生理（PCS）综合评分的改善情况。
背景数据总结
ACDF通过患者报告的结果进行评估。然而，ACDF后这些结果改善的程度仍不清楚。
方法
回顾了2013年至2015年期间接受初次单节段或双节段ACDF手术患者的手术登记资料。使用配对t检验对术前至每个术后时间点的VAS颈部和手臂疼痛、NDI以及SF - 12 MCS和PCS评分进行比较。采用方差分析（ANOVA）估计术后第一年颈部和手臂疼痛的减轻情况。对以颈部疼痛为主（pNP）或手臂疼痛为主（pAP）的患者以及单节段与双节段ACDF患者进行亚组分析。
结果
共纳入89例患者。VAS颈部和手臂疼痛、NDI以及SF - 12 PCS在所有术后时间点均较术前评分有所改善（每项P < 0.05）。在术后第一年，患者报告颈部疼痛减轻2.7分（44.2%），手臂疼痛减轻3.1分（54.0%）（每项P < 0.05）。61例pNP患者和28例pAP患者分别在术后前6个月和12周报告颈部和手臂疼痛减轻（每项P < 0.05）。接受单节段ACDF的患者在术后第一年颈部疼痛减轻47.2%，手臂疼痛减轻55.1%（每项P < 0.05），而接受双节段ACDF的患者颈部和手臂疼痛分别减轻39.7%和49.2%（每项P < 0.05）。
结论
本研究表明，无论初始症状如何，患者在ACDF后颈部和手臂疼痛均有显著改善。此外，接受单节段ACDF的患者报告颈部和手臂疼痛减轻程度大于接受双节段融合的患者。
证据等级
4级。
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