Zheng Bolong, Hao Dingjun, Guo Hua, He Baorong
Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, NO555,East Friendship Rd, Xi'an, Shanxi, 86710054, China.
BMC Surg. 2017 Nov 28;17(1):113. doi: 10.1186/s12893-017-0316-9.
ACDF has been considered as the gold standard in the treatment of single level cervical disk protrusion. However, it may cause adjacent level degeneration due to regional biomechanical changes. TDR has been applied with satisfactory results for over a decade, but there is no consensus if TDR is safer and more efficient than ACDF. The current study was carried out to compare the efficiency and safety of TDR and ACDF in the treatment of patients with single level cervical disk protrusion.
One hundred forty-five consecutive patients who underwent either TDR or ACDF in our center were included in the current study. Time of surgery, intraoperative blood loss, VAS arm and neck pain scores, ROM, ODI, SF36 and Patient satisfaction were compared before the surgery, after the surgery, and during follow up 1, 3, 5, 8 years after the surgery.
The time of surgery was 64.6 ± 20.7 min in the ACDF group and 69.4 ± 19.3 min in the TDR group; intraoperative hemorrhage was 67.2 ± 14.3 ml in ACDF group and 70.7 ± 18.6 ml in TDR group. There were no significant differences between two groups concerning time of surgery and intraoperative blood loss. No differences were found concerning patient satisfaction between the two groups during the follow up (P > 0.05). Significant differences were found between the groups concerning VAS arm and neck pain scores, ROM, ODI and SF36 after the surgery and during the 8 year follow up.
TDR may be a more effective approach than ACDF for treating patients with single level cervical disk protrusion.
前路颈椎间盘切除融合术（ACDF）一直被视为治疗单节段颈椎间盘突出症的金标准。然而，由于局部生物力学改变，它可能导致相邻节段退变。人工颈椎间盘置换术（TDR）已应用十多年，效果令人满意，但对于TDR是否比ACDF更安全、更有效尚无共识。本研究旨在比较TDR和ACDF治疗单节段颈椎间盘突出症患者的有效性和安全性。
本研究纳入了在我们中心连续接受TDR或ACDF手术的145例患者。比较手术时间、术中失血量、视觉模拟评分法（VAS）上肢和颈部疼痛评分、活动度（ROM）、颈椎功能障碍指数（ODI）、简明健康状况调查量表（SF36）以及患者满意度，这些指标在手术前、手术后以及术后1、3、5、8年的随访期间进行评估。
ACDF组手术时间为64.6±20.7分钟，TDR组为69.4±19.3分钟；ACDF组术中出血量为67.2±14.3毫升，TDR组为70.7±18.6毫升。两组在手术时间和术中失血量方面无显著差异。随访期间两组患者满意度无差异（P>0.05）。两组在术后及8年随访期间，在VAS上肢和颈部疼痛评分、ROM、ODI和SF36方面存在显著差异。
对于治疗单节段颈椎间盘突出症患者，TDR可能是比ACDF更有效的方法。
