Dunn Conor, Moore Jeffrey, Sahai Nikhil, Issa Kimona, Faloon Michael, Sinha Kumar, Hwang Ki Soo, Emami Arash
J Neurosurg Spine. 2018 Oct;29(4):358-364. doi: 10.3171/2018.2.SPINE171003. Epub 2018 Jun 29.
The objective of this study was to compare anterior cervical discectomy and fusion (ACDF) and minimally invasive posterior cervical foraminotomy (MI-PCF) with tubes for the treatment of cervical radiculopathy in terms of the 1) overall revision proportion, 2) index and adjacent level revision rates, and 3) functional outcome scores.
The authors retrospectively reviewed the records of consecutive patients who had undergone ACDF or MI-PCF at a single institution between 2009 and 2014. Patients treated for cervical radiculopathy without myelopathy and with a minimum 2-year follow-up were compared according to the procedure performed for their pathology. Primary outcome measures included the overall rate of revision with fusion and overall revision proportion as well as the rate of index and adjacent level revisions per year. Secondarily, self-reported outcome measures-Neck Disability Index (NDI) and visual analog scale (VAS) for arm (VASa) and neck (VASn) pain-at the preoperative and postoperative evaluations were analyzed. Standard binomial and categorical comparative analyses were performed.
Forty-nine consecutive patients were treated with MI-PCF, and 210 consecutive patients were treated with ACDF. The mean follow-up for the MI-PCF cohort was 42.9 ± 6.6 months (mean ± SD) and for the ACDF cohort was 44.9 ± 10.3 months. There was no difference in the overall revision proportion between the two cohorts (4 [8.2%] of 49 MI-PCF vs. 12 [5.7%] of 210 ACDF, p = 0.5137). There was no difference in the revision rate per level per year (3.1 vs. 1.7, respectively, p = 0.464). Moreover, there was no difference in the revision rate per level per year at the index level (1.8 vs. 0.7, respectively, p = 0.4657) or at an adjacent level (1.3 vs. 1.1, p = 0.9056). Neither was there a difference between the cohorts as regards the change from preoperative to final postoperative functional outcome scores (NDI, VASa, VASn).
Minimally invasive PCF for the treatment of cervical radiculopathy demonstrates rates of revision at the index and adjacent levels similar to those following ACDF. In order to confirm the positive efficacy and cost analysis findings in this study, future studies need to extend the follow-up and show that the rate of revision with fusion does not increase substantially over time.
本研究的目的是比较前路颈椎间盘切除融合术（ACDF）和带通道的微创后路颈椎椎间孔切开术（MI-PCF）在治疗神经根型颈椎病方面的1）总体翻修比例、2）责任节段和相邻节段翻修率以及3）功能结局评分。
作者回顾性分析了2009年至2014年在单一机构接受ACDF或MI-PCF治疗的连续患者的记录。对因神经根型颈椎病且无脊髓病接受治疗并至少随访2年的患者，根据其病理所行手术进行比较。主要结局指标包括融合翻修的总体发生率、总体翻修比例以及每年责任节段和相邻节段的翻修率。其次，分析术前和术后评估时自我报告的结局指标——颈部功能障碍指数（NDI）以及手臂（VASa）和颈部（VASn）疼痛的视觉模拟量表。进行标准二项式和分类比较分析。
49例连续患者接受了MI-PCF治疗，210例连续患者接受了ACDF治疗。MI-PCF队列的平均随访时间为42.9±6.6个月（均值±标准差），ACDF队列的平均随访时间为44.9±10.3个月。两组队列的总体翻修比例无差异（49例MI-PCF中有4例[8.2%]，210例ACDF中有12例[5.7%]，p = 0.5137）。每年每个节段的翻修率无差异（分别为3.1和1.7，p = 0.464）。此外，责任节段每年每个节段的翻修率（分别为1.8和0.7，p = 0.4657）或相邻节段（1.3和1.1，p = 0.9056）也无差异。两组队列在术前至最终术后功能结局评分（NDI、VASa、VASn）的变化方面也无差异。
用于治疗神经根型颈椎病的微创PCF在责任节段和相邻节段的翻修率与ACDF术后相似。为了证实本研究中的阳性疗效和成本分析结果，未来的研究需要延长随访时间，并表明融合翻修率不会随时间大幅增加。
