Tian Wei, Yan Kai, Han Xiao, Yu Jie, Jin Peihao, Han Xiaoguang
Department of Spine Surgery, Beijing Jishuitan Hospital, Xicheng District, Beijing, China.
Clin Spine Surg. 2017 Jun;30(5):E578-E586. doi: 10.1097/BSD.0000000000000206.
Prospective nonrandomized comparative study.
To compare the long-term clinical and radiographic results of cervical artificial disk replacement (CADR) and anterior cervical discectomy and fusion (ACDF), and to provide our evidence if CADR could reduce adjacent segment degeneration (ASD).
CADR is widely used in spine surgery today. Despite the short-term results of it having been ascertained, the long-term results are still under observation. Meanwhile it is still debatable if CADR could reduce ASD in the long run.
Sixty-three patients with cervical myelopathy who underwent CADR (28) or ACDF (35) with a minimum follow-up of 68 months were included. Japanese Orthopaedic Association score, neck disability index, and Odom's scale were used to evaluate the clinical outcomes. Radiographs, computed tomography, and magnetic resonance imaging were used to evaluate the radiographic outcomes.
Both CADR and ACDF groups showed significant improvement on Japanese Orthopaedic Association scores and neck disability index, and there was no significant difference between the 2 groups. The sagittal alignment was maintained for both the groups. The C2-C7 range of motion had no significant change for CADR group, whereas it significantly decreased for ACDF group. The range of motion at index level of CADR patients decreased from 9.5±3.7 degrees before surgery to 7.0±3.0 degrees at 3 months after surgery (P<0.001), and it was maintained to 6.6±4.1 degrees at last follow-up without significant decrease (P=0.448). We used radiographic data to evaluate ASD and we found the incidence of ASD was significantly lower for CADR group than ACDF group.
The clinical and radiographic results of CADR over 6-year follow-up are basically satisfying. Compared with ACDF, CADR could better preserve physiological motion and biomechanics of cervical spine, and reduce the occurrence of ASD.
前瞻性非随机对照研究。
比较颈椎人工椎间盘置换术（CADR）与颈椎前路椎间盘切除融合术（ACDF）的长期临床和影像学结果，并提供关于CADR是否能减少相邻节段退变（ASD）的证据。
CADR如今在脊柱外科中被广泛应用。尽管其短期结果已得到确定，但其长期结果仍在观察中。同时，从长远来看CADR是否能减少ASD仍存在争议。
纳入63例接受CADR（28例）或ACDF（35例）且随访至少68个月的脊髓型颈椎病患者。采用日本骨科协会评分、颈部功能障碍指数和奥多姆量表评估临床结果。利用X线片、计算机断层扫描和磁共振成像评估影像学结果。
CADR组和ACDF组在日本骨科协会评分和颈部功能障碍指数方面均有显著改善，两组之间无显著差异。两组矢状面排列均得以维持。CADR组C2-C7活动度无显著变化，而ACDF组显著降低。CADR患者手术节段活动度从术前的9.5±3.7度降至术后3个月的7.0±3.0度（P<0.001），并在末次随访时维持在6.6±4.1度，无显著下降（P=0.448）。我们利用影像学数据评估ASD，发现CADR组ASD发生率显著低于ACDF组。
CADR超过6年随访的临床和影像学结果基本令人满意。与ACDF相比，CADR能更好地保留颈椎的生理活动度和生物力学，并减少ASD的发生。
