Ji Gyu Yeul, Oh Chang Hyun, Shin Dong Ah, Ha Yoon, Yi Seong, Kim Keung Nyun, Shin Hyun Cheol, Yoon Do Heum
*Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University College of Medicine, Seoul, Korea †Department of Neurosurgery, Guro Cham Teun Teun Hospital, Seoul, Korea ‡Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea.
Clin Spine Surg. 2017 Jun;30(5):E620-E627. doi: 10.1097/BSD.0000000000000316.
Prospective study.
The purpose of this study was to compare the long-term clinical and radiologic outcomes of hybrid surgery (HS) and 2-level anterior cervical discectomy and fusion (2-ACDF) in patients with 2-level cervical disk disease.
In a previous study with a 2-year follow-up, HS was shown to be superior to 2-ACDF, with a better Neck Disability Index (NDI) score, less postoperative neck pain, faster C2-C7 range of motion (ROM) recovery, and less adjacent ROM increase.
Between 2004 and 2006, 40 patients undergoing 2-level cervical disk surgery at our hospital were identified as 2-level degenerative disk disease. Forty patients were included in the previous study; 35 patients were followed up for 5 years. Patients completed the NDI and graded their pain intensity before surgery and at routine postoperative until 5 years. Dynamic cervical radiographs were obtained before surgery and at routine postoperative intervals and the angular ROM for C2-C7 and adjacent segments was measured.
The HS group had better NDI recovery until 3 years after surgery (P<0.05). Postoperative neck pain was lower in the HS group at 1 and 3 years after surgery (P<0.05), but arm pain relief was not differently relieved. The HS group showed more angular ROM for C2-C7 at 2 and 3 years after surgery. The superior adjacent segment ROM showed hypermobility in the 2-ACDF group and hypomobility in the HS group at all follow-up periods without statistically significance, but the inferior adjacent segment ROM differed significantly (P<0.05).
HS is superior to 2-ACDF; it leads to better NDI recovery, less postoperative neck pain, faster C2-C7 ROM recovery, and less adjacent ROM increase over a 2-year follow-up, but these benefits of HS become similar to those of 2-ACDF with 5 years of follow-up.
前瞻性研究。
本研究旨在比较混合手术（HS）与二级颈椎间盘切除术及融合术（2-ACDF）治疗二级颈椎间盘疾病患者的长期临床和影像学结果。
在一项为期2年随访的先前研究中，HS被证明优于2-ACDF，具有更好的颈部功能障碍指数（NDI）评分、术后颈部疼痛更少、C2-C7活动范围（ROM）恢复更快以及相邻节段ROM增加更少。
2004年至2006年期间，在我院接受二级颈椎间盘手术的40例患者被确诊为二级退行性椎间盘疾病。先前研究纳入了40例患者；35例患者进行了5年的随访。患者在手术前及术后常规随访直至5年时完成NDI并对疼痛强度进行分级。在手术前及术后常规随访间隔期拍摄颈椎动态X线片，并测量C2-C7及相邻节段的角ROM。
HS组在术后3年内NDI恢复情况更好（P<0.05）。HS组在术后1年和3年时的术后颈部疼痛更低（P<0.05），但手臂疼痛缓解情况无差异。HS组在术后2年和3年时C2-C7的角ROM更大。在所有随访期，2-ACDF组的上位相邻节段ROM显示活动过度，HS组显示活动不足，无统计学意义，但下位相邻节段ROM差异有统计学意义（P<0.05）。
HS优于2-ACDF；在2年的随访中，它能带来更好的NDI恢复、更少的术后颈部疼痛、更快的C2-C7 ROM恢复以及更少的相邻节段ROM增加，但HS的这些优势在5年随访时与2-ACDF相似。
