Wu Ting-Kui, Wang Bei-Yu, Deng Ming-Dan, Hong Ying, Rong Xin, Chen Hua, Meng Yang, Liu Hao
Department of Orthopedic Surgery, West China Hospital West China School of Medicine, Sichuan University, Chengdu, China.
Medicine (Baltimore). 2017 Oct;96(41):e8112. doi: 10.1097/MD.0000000000008112.
Anterior cervical discectomy and fusion (ACDF) has been widely performed for the treatment of multilevel cervical degenerative disc disease (CDDD). In recent decades, cervical disc arthroplasty (CDA) and hybrid surgery (HS) have been developed to overcome the shortcomings of ACDF. Controversy still remains with regard to the optimal surgical procedure for skip-level CDDD.A total of 55 patients who received surgical treatment for skip-level CDDD in our department were reviewed. The patients were divided into the HS group (n = 29) and the CDA group (n = 26). The collected data included Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analog Scale (VAS) scores, and cervical lordosis (CL), range of motion (ROM), and intervertebral disc height (IDH). Radiological changes at the intermediate segment (IS) were also collected. All data were collected preoperatively and at routine postoperative intervals of 1 week and 3, 6, and 12 months and at the last follow-up period.Compared with preoperative values, mean JOA, NDI, and VAS scores significantly improved after surgery in both the HS and CDA groups (P < .05). However, there were no significant differences between the groups (P > .05). The HS group had better CL recovery than the CDA group after surgery (P < .05). There was no significant difference in the ROM of C2-C7 between the 2 groups (P > .05). A significant difference in the ROM of the IS was found at the last follow-up between the 2 groups (P < .05). At the last-follow-up, 4 discs (14.29%) in the CDA group and 6 discs (19.36%) in the HS group had adjacent segment degeneration (ASD) without symptoms.Both HS and CDA might be considered safe and effective surgical strategies for the treatment of skip-level CDDD. Although the clinical outcomes were similar in the 2 groups, CDA altered the ROM of the IS to a lesser degree.
前路颈椎间盘切除融合术（ACDF）已被广泛用于治疗多节段颈椎退行性椎间盘疾病（CDDD）。近几十年来，颈椎间盘置换术（CDA）和混合手术（HS）已被开发出来以克服ACDF的缺点。对于跳跃节段CDDD的最佳手术方法仍存在争议。
对我院接受跳跃节段CDDD手术治疗的55例患者进行了回顾性研究。患者分为HS组（n = 29）和CDA组（n = 26）。收集的数据包括日本骨科协会（JOA）评分、颈部功能障碍指数（NDI）、视觉模拟量表（VAS）评分，以及颈椎前凸（CL）、活动范围（ROM）和椎间盘高度（IDH）。还收集了中间节段（IS）的影像学变化。所有数据均在术前以及术后1周、3、6和12个月的常规随访期以及最后随访期收集。
与术前值相比，HS组和CDA组术后JOA、NDI和VAS平均评分均显著改善（P < 0.05）。然而，两组之间无显著差异（P > 0.05）。术后HS组的CL恢复情况优于CDA组（P < 0.05）。两组C2-C7的ROM无显著差异（P > 0.05）。两组在最后随访时IS的ROM存在显著差异（P < 0.05）。在最后随访时，CDA组有4个椎间盘（14.29%）、HS组有6个椎间盘（19.36%）出现无症状的相邻节段退变（ASD）。
HS和CDA都可被认为是治疗跳跃节段CDDD的安全有效的手术策略。虽然两组的临床结果相似，但CDA对IS的ROM改变程度较小。
