Zarkadis Nicholas J, Cleveland Andrew W, Kusnezov Nicholas A, Dunn John C, Caram Pedro M, Herzog Joshua P
Department of Orthopaedics Surgery and Rehabilitation, William Beaumont Army Medical Center, 5005 North Piedras, El Paso, TX 79920.
Department of Neurosurgery, William Beaumont Army Medical Center, 5005 North Piedras, El Paso, TX 79920.
Mil Med. 2017 Mar;182(3):e1790-e1794. doi: 10.7205/MILMED-D-16-00085.
Cervical radiculopathy is a common disorder that portends significant morbidity. The presence of radiculopathy can have a debilitating effect on patients as well as a significant economic impact. Active duty military patients with increased physical occupational demands can be significantly impacted by cervical disease. The resulting disability can have a strong negative impact on operational readiness. Several studies have demonstrated comparably good functional outcomes between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion for single-level disease. To date, no study has specifically evaluated the functional and occupational outcomes following adjacent 2-level CDA in a young, active patient population as represented by the active duty military population.
To evaluate functional and occupational outcomes following adjacent 2-level CDA for cervical radiculopathy in the U.S. military population. We hypothesized that this population would have excellent symptomatic relief at the cost of a low return to duty rate.
We performed a case series with prospective follow-up of all patients who underwent adjacent two-level CDA at a single institution from 2011 to 2014. Each patient completed the Neck Disability Index questionnaire to assess functional outcome. Primary outcomes of interest were return to active military duty and complications.
Follow-up was available for 18 of 21 (85.7%) patients. At an average follow-up of 21.4 ± 11.1 months, 12 patients (66.7%) reported complete symptomatic relief and were able to return to preoperative levels of function. Average self-reported pain score improved from 8.3 preoperatively to 1.1 postoperatively, and average postoperative Neck Disability Index score was 15.5 compared to 37.0 for those who medically retired. Radiographic analysis did not show any evidence of subsidence, migration of hardware, or heterotopic ossification. The average return to duty time was 9.6 weeks.
We demonstrate that adjacent two-level CDA is capable of providing predictable symptomatic relief and maintenance of a high-demand preoperative level of function for cervical radiculopathy among a population of young and highly active individuals. Adjacent two-level CDA offers significant relief of symptoms with low risk of complication in a young, active, and high-demand cohort such as the U.S. military. Adjacent two-level CDA can be performed with the expectation of improving function, relieving symptoms, returning to preoperative levels of activity, and maintaining operational readiness.
神经根型颈椎病是一种常见疾病，预示着较高的发病率。神经根病的存在会对患者产生衰弱性影响，并造成重大经济影响。对身体职业要求较高的现役军人患者可能会受到颈椎病的显著影响。由此导致的残疾会对作战准备产生严重负面影响。多项研究表明，对于单节段疾病，颈椎间盘置换术（CDA）与颈椎前路椎间盘切除融合术的功能结局相当。迄今为止，尚无研究专门评估以现役军人为代表的年轻、活跃患者群体中相邻双节段CDA术后的功能和职业结局。
评估美国军人中相邻双节段CDA治疗神经根型颈椎病后的功能和职业结局。我们假设该群体将获得极佳的症状缓解，但重返工作岗位的比率较低。
我们对2011年至2014年在单一机构接受相邻双节段CDA的所有患者进行了前瞻性随访的病例系列研究。每位患者完成颈部功能障碍指数问卷以评估功能结局。主要关注的结局是重返现役和并发症。
21例患者中有18例（85.7%）获得随访。平均随访21.4±11.1个月时，12例患者（66.7%）报告症状完全缓解，能够恢复到术前功能水平。自我报告的平均疼痛评分从术前的8.3分改善至术后的1.1分，术后颈部功能障碍指数平均评分为15.5分，而因病退休者为37.0分。影像学分析未显示任何下沉、植入物移位或异位骨化的证据。平均重返工作岗位时间为9.6周。
我们证明，相邻双节段CDA能够为年轻且高度活跃的神经根型颈椎病患者群体提供可预测的症状缓解，并维持术前高要求的功能水平。相邻双节段CDA在年轻、活跃且要求较高的群体（如美国军人）中能显著缓解症状，并发症风险低。进行相邻双节段CDA有望改善功能、缓解症状、恢复到术前活动水平并维持作战准备状态。
