Li Jia, Zhang Di, Ding Wenyuan, Zhang Yingze, Shen Yong
*Department of Orthopaedic Surgery †The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Clin Spine Surg. 2017 Oct;30(8):E1088-E1092. doi: 10.1097/BSD.0000000000000226.
A retrospective investigation.
The aim of this research is to compare the clinical and radiologic outcomes of patients with Modic-2 changes who underwent anterior cervical discectomy and fusion (ACDF) or cervical total disk replacement (TDR) in single level.
There were few studies focused on the clinical and radiologic outcomes of patients with Modic-2 changes who underwent ACDF or cervical TDR in single level.
A total of 76 patients with Modic-2 changes who underwent TDR or ACDF with complete follow-up data were analyzed retrospectively. Patients with chronic axial symptoms resulting from single-level cervical spine disease manifested as radiculopathy or myelopathy following 6 months of invalid conservative treatment. Clinical evaluations were performed preoperatively and repeated at 5 years after operation.
In this study, a total of 72 patients (94.7%) with a minimum of 5 years of follow-up data were available for analysis. There were 35 (18 men and 17 women) in the TDR group and 37 (20 men and 17 women) in the ACDF group. There was no difference in preoperative Japanese Orthopedic Association, Neck Disability Index, range of motion (ROM), and Visual Analogue Scale (VAS), on arm pain and neck pain between the 2 groups (P=0.663), but the TDR group showed significant differences in VAS for neck pain and ROM compared with that of the ACDF group at the last follow-up (P<0.05). Both groups reported significant improvements in Japanese Orthopedic Association, Neck Disability Index, ROM, and VAS, on arm pain and neck pain from the preoperative means (P<0.05).
Patients with Modic-2 changes in TDR group received a large discectomy and leading to the removal of the majority of the inflammatory disk tissue. TDR is a significantly better maintenance of index-level ROM than ACDF. The mid-term outcomes demonstrated that the both TDR and ACDF groups maintain favorable clinical results on patients with Modic-2 changes, who received TDR have significantly better maintenance of ROM than ACDF.
一项回顾性调查。
本研究旨在比较单节段颈椎间盘退变Modic-2型改变患者接受前路颈椎间盘切除融合术（ACDF）或颈椎全椎间盘置换术（TDR）后的临床和影像学结果。
很少有研究关注单节段颈椎间盘退变Modic-2型改变患者接受ACDF或颈椎TDR后的临床和影像学结果。
回顾性分析76例接受TDR或ACDF且有完整随访数据的Modic-2型改变患者。单节段颈椎病导致慢性轴性症状的患者，经6个月无效保守治疗后表现为神经根病或脊髓病。术前进行临床评估，并在术后5年重复评估。
本研究中，共有72例（94.7%）患者有至少5年的随访数据可供分析。TDR组35例（男18例，女17例），ACDF组37例（男20例，女17例）。两组术前日本骨科协会评分、颈部功能障碍指数、活动范围（ROM）和视觉模拟量表（VAS）中的手臂疼痛和颈部疼痛评分无差异（P = 0.663），但在末次随访时，TDR组颈部疼痛VAS评分和ROM与ACDF组相比有显著差异（P < 0.05）。两组患者的日本骨科协会评分、颈部功能障碍指数、ROM以及VAS中的手臂疼痛和颈部疼痛评分与术前相比均有显著改善（P < 0.05）。
TDR组Modic-2型改变患者接受了较大范围的椎间盘切除术，导致大部分炎性椎间盘组织被切除。TDR在维持手术节段ROM方面明显优于ACDF。中期结果表明，TDR和ACDF两组对Modic-2型改变患者均能维持良好的临床效果，接受TDR的患者在ROM维持方面明显优于ACDF。
