Shen Yong, Du Wei, Wang Lin-Feng, Dong Zhen, Wang Feng
Department of Spine Surgery, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, China.
Department of Spine Surgery, The Third Hospital of Hebei Medical University, The Key Laboratory of Orthopedic Biomechanics of Hebei Province, Shijiazhuang, China.
World Neurosurg. 2018 Jul;115:e226-e232. doi: 10.1016/j.wneu.2018.04.019. Epub 2018 Apr 12.
The purpose of this study was to compare the clinical efficacy of anterior cervical discectomy and fusion (ACDF) with Zero-profile device (Zero-p) and traditional cervical plate-and-cage implant in the treatment of symptomatic adjacent segment disease (ASD) and to determine the optimal reoperation procedure.
This was a retrospective study of 58 patients with symptomatic ASD after an initial ACDF surgery and who had undergone a reoperation with ACDF with Zero-p (n = 27) and cervical plate-and-cage (n = 31) at our medical center between January 2010 and December 2015.
The Japanese Orthopaedic Association score, Neck Disability Index score, Visual Analog Scale score, C2-C7 Cobb angle, and disc height index demonstrated significant improvements compared with the preoperative in both Zero-p and plate-and-cage groups (P < 0.05). However, there were no differences between the two groups (P > 0.05). The reoperation time for the Zero-p group (83.4 ± 18.9 min) was less than that for the plate-and-cage group (96.5 ± 20.1 min), with significant difference (P < 0.05). Five patients (8.6%) had cage subsidence, and 14 patients (24.1%) had dysphagia after the reoperation. There was no statistical significance in the difference between the 2 groups in cage subsidence (P > 0.05). However, the incidence of dysphagia in the plate-and-cage group (38.7%) was higher than in the Zero-p group (7.4%), with a significant difference (P < 0.05).
ACDF with Zero-p obtaining the same surgical efficacy, compared with traditional cervical plate-and-cage, can significantly shorten the reoperation time and reduce the incidence of postoperative dysphagia. This option may be preferable for symptomatic patients with ASD qualifying for the anterior approach, in terms of biomechanics and surgical outcomes.
本研究旨在比较采用零切迹椎间融合器（Zero-p）的颈椎前路椎间盘切除融合术（ACDF）与传统颈椎钢板-椎间融合器植入术治疗症状性相邻节段疾病（ASD）的临床疗效，并确定最佳的再次手术方案。
这是一项回顾性研究，纳入了2010年1月至2015年12月期间在我院接受初次ACDF手术后因症状性ASD而再次接受ACDF手术的58例患者，其中采用Zero-p的有27例，采用颈椎钢板-椎间融合器植入术的有31例。
与术前相比，Zero-p组和钢板-椎间融合器组的日本骨科协会评分、颈部功能障碍指数评分、视觉模拟量表评分、C2-C7 Cobb角和椎间盘高度指数均有显著改善（P < 0.05）。然而，两组之间无差异（P > 0.05）。Zero-p组的再次手术时间（83.4 ± 18.9分钟）短于钢板-椎间融合器组（96.5 ± 20.1分钟），差异有统计学意义（P < 0.05）。再次手术后，5例患者（8.6%）出现椎间融合器下沉，14例患者（24.1%）出现吞咽困难。两组间椎间融合器下沉差异无统计学意义（P > 0.05）。然而，钢板-椎间融合器组吞咽困难的发生率（38.7%）高于Zero-p组（7.4%），差异有统计学意义（P < 0.05）。
与传统颈椎钢板-椎间融合器相比，采用Zero-p的ACDF具有相同的手术疗效，可显著缩短再次手术时间并降低术后吞咽困难的发生率。就生物力学和手术效果而言，对于符合前路手术指征的症状性ASD患者，该方案可能更可取。
