Spanos Savvas L, Siasios Ioannis D, Dimopoulos Vassilios G, Paterakis Konstantinos N, Mastrogiannis Dimos S, Giannis Theofanis P, Fotiadou Aggeliki A, Pollina John, Fountas Kostas N
Department of Neurosurgery, School of Medicine, University of Thessaly, Larissa, Greece.
Department of Physiotherapy, School of Health and Welfare, Technological Education Institute of Sterea Ellada, Lamia, Greece.
J Clin Med Res. 2018 Mar;10(3):268-276. doi: 10.14740/jocmr3326w. Epub 2018 Jan 26.
Anterior cervical discectomy and fusion (ACDF) with a polyetheretherketone (PEEK) cage is considered as the gold standard for patients with cervical disc disease. However, there are limited data on the impact of ACDF on the cervical kinematics and its association with patient-reported clinical outcomes. The purpose of this study was to investigate the impact of altered cervical sagittal alignment (cervical lordosis) and sagittal range of motion (ROM) on patients' self-reported pain and functional disability, after ACDF with a PEEK cage.
We prospectively studied 74 patients, who underwent single-, or consecutive two-level ACDF with a PEEK interbody cage. The clinical outcomes were assessed by using the pain numeric rating scale (NRS) and the neck disability index (NDI). Radiological outcomes included cervical lordosis and C2-C7 sagittal ROM. The outcome measures were collected preoperatively, at the day of patients' hospital discharge, and also at 6 and 12 months postoperatively.
There was a statistically significant reduction of the NRS and NDI scores postoperatively at each time point (P < 0.005). Cervical lordosis and also ROM significantly reduced until the last follow-up (P < 0.005). There was significant positive correlation between NRS and NDI preoperatively, as well as at 6 and 12 months postoperatively (P < 0.005). In regard to the ROM and the NDI scores, there was no correlation preoperatively (P = 0.199) or postoperatively (6 months, P = 0.322; 12 months, P = 0.476). Additionally, there was no preoperative (P = 0.134) or postoperative (6 months, P = 0.772; 12 months, P = 0.335) correlation between the NDI scores and cervical lordosis.
In our study, reduction of cervical lordosis and sagittal ROM did not appear to significantly influence on patients' self-reported disability. Such findings further highlight the greater role of pain level over the mechanical limitations of ACDF with a PEEK cage on patients' own perceived recovery.
聚醚醚酮（PEEK）椎间融合器前路颈椎间盘切除融合术（ACDF）被认为是治疗颈椎间盘疾病患者的金标准。然而，关于ACDF对颈椎运动学的影响及其与患者报告的临床结果之间的关联的数据有限。本研究的目的是探讨在使用PEEK椎间融合器进行ACDF后，颈椎矢状位排列改变（颈椎前凸）和矢状位活动度（ROM）对患者自我报告的疼痛和功能障碍的影响。
我们前瞻性地研究了74例接受单节段或连续双节段PEEK椎间融合器ACDF的患者。使用疼痛数字评分量表（NRS）和颈部功能障碍指数（NDI）评估临床结果。放射学结果包括颈椎前凸和C2-C7矢状位ROM。在术前、患者出院当天以及术后6个月和12个月收集结果指标。
在每个时间点，术后NRS和NDI评分均有统计学意义的降低（P < 0.005）。直到最后一次随访，颈椎前凸和ROM均显著降低（P < 0.005）。术前以及术后6个月和12个月，NRS和NDI之间存在显著正相关（P < 0.005）。关于ROM和NDI评分，术前（P = 0.199）或术后（6个月，P = 0.322；12个月，P = 0.476）均无相关性。此外，术前（P = 0.134）或术后（6个月，P = 0.772；12个月，P = 0.335）NDI评分与颈椎前凸之间均无相关性。
在我们的研究中，颈椎前凸和矢状位ROM的降低似乎并未对患者自我报告的功能障碍产生显著影响。这些发现进一步凸显了疼痛程度在使用PEEK椎间融合器的ACDF对患者自身感知恢复的机械限制方面所起的更大作用。
