Wang Kai-Feng, Duan Shuo, Zhu Zhen-Qi, Liu Hai-Ying, Liu Chen-Jun, Xu Shuai
Department of Spine Surgery, Peking University People's Hospital, Beijing, China.
Department of Spine Surgery, Peking University People's Hospital, Beijing, China.
World Neurosurg. 2018 May;113:e70-e76. doi: 10.1016/j.wneu.2018.01.157. Epub 2018 Jan 31.
To assess the mid-long-term follow-up of the safety and efficacy of anterior cervical discectomy and fusion (ACDF), cervical artificial disc replacement (CADR) and hybrid surgery (HS) for bilevel cervical degenerative disc disease (cDDD).
77 patients who underwent ACDF, HS, and CADR were retrospectively reviewed. Clinical effects were evaluated based on Neck Disability Index (NDI), Visual Analog Scale (VAS), and Japanese Orthopedic Association (JOA) scores and the Odom criteria. Radiographic outcomes were evaluated, including cervical range of motion (ROM), ROM in the operative and adjacent segments, incidence of degeneration in the adjacent segments (ASD), and heterotopic ossification (HO).
NDI, VAS, and JOA scores significantly improved in all patients after surgery without significant differences between groups. The excellent-to-good ratio in the Odom scale was 28/30 for the HS group, 30/33 for the ACDF group, and 13/14 for the CADR group. No significant differences in clinical outcomes or complication were found between groups (P > 0.05). Furthermore, the HS and CADR groups had less decreased ROM in the cervical and operative segments and less compensatory ROM in adjacent segments (P < 0.05). By contrast, the ACDF group had decreased ROM in the cervical and operative segments and significantly increased ROM in adjacent segments (P < 0.05). Moreover, the incidence of ASD was higher in the ACDF group, but the difference was not statistically significant (P > 0.05). HO was found in 10 patients (33.3%) in the HS group and 5 patients (35.7%) in the CADR group.
HS was superior to ACDF with regard to equivalent clinical outcomes in the mid-long-term follow-up. Furthermore, HS was superior in the maintenance of ROM and had less impact on its adjacent segments. The efficacy of HS is similar to that of CADR.
评估前路颈椎间盘切除融合术（ACDF）、颈椎人工椎间盘置换术（CADR）和混合手术（HS）治疗双节段颈椎退行性椎间盘疾病（cDDD）的中长期安全性和有效性。
回顾性分析77例行ACDF、HS和CADR手术的患者。基于颈部功能障碍指数（NDI）、视觉模拟量表（VAS）、日本骨科协会（JOA）评分和奥多姆标准评估临床效果。评估影像学结果，包括颈椎活动度（ROM）、手术节段和相邻节段的ROM、相邻节段退变（ASD）的发生率以及异位骨化（HO）。
所有患者术后NDI、VAS和JOA评分均显著改善，组间无显著差异。奥多姆量表中，HS组优良率为28/30，ACDF组为30/33，CADR组为13/14。组间临床结果或并发症无显著差异（P>0.05）。此外，HS组和CADR组颈椎和手术节段的ROM减少较少，相邻节段的代偿性ROM较少（P<0.05）。相比之下，ACDF组颈椎和手术节段的ROM减少，相邻节段的ROM显著增加（P<0.05）。此外，ACDF组ASD的发生率较高，但差异无统计学意义（P>0.05）。HS组有10例患者（33.3%）出现HO，CADR组有5例患者（35.7%）出现HO。
在中长期随访中，HS在等效临床结果方面优于ACDF。此外，HS在维持ROM方面更具优势，对相邻节段的影响较小。HS的疗效与CADR相似。
