Zhang Junxin, Liu Hao, Bou Emily Hong, Jiang Weimin, Zhou Feng, He Fan, Yang Huilin, Liu Tao
Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Biochemistry Department, University of Waterloo, Waterloo, Canada.
World Neurosurg. 2019 Jan;121:e917-e924. doi: 10.1016/j.wneu.2018.10.016. Epub 2018 Oct 12.
Selection of anterior versus posterior surgery for multilevel (≥3) cervical spondylotic myelopathy (MCSM) continues to be controversial. A comparison between anterior cervical discectomy and fusion (ACDF) with ROI-C cage and laminoplasty was made to determine the better treatment for MCSM.
Between 2012 and 2017, 57 patients received either ACDF with ROI-C or laminoplasty (LMP) treatment. Clinical and radiologic outcomes between the 2 groups were compared.
In total, 24 patients underwent ACDF with ROI-C cage (ACDF group) and 33 patients underwent LMP (LMP group). They were studied with a median follow-up of 22 months. Less operative blood loss (136.7 ± 60.8 vs. 316.7 ± 139.6 mL, P < 0.001) and a shorter hospital stay (7.8 ± 1.6 vs. 9.9 ± 3.3 days, P < 0.01) were notable for ACDF. The Japanese Orthopedic Association score showed that ACDF and LMP improved similarly (recovery rate, 55.3 ± 19.2% vs. 58.9 ± 18.1%, P > 0.05). Preoperative occupying rate and JOA score significantly affected the operation result (P < 0.01). The cervical lordosis, segmental cervical lordosis, and T1 slope were all larger in the ACDF group. The cervical range of motion decreased 10.6° in the ACDF group and 4.8° in the LMP group (P = 0.01). No significant differences were found between complication rates.
ACDF with ROI-C cage has a similar clinical efficacy to LMP for patients with MCSM. There was less blood loss, shorter hospital stays, and improved sagittal balance when ACDF was used. However, a greater decrease in range of motion was observed after ACDF. Preoperative occupying ratio and Japanese Orthopaedic Association score are potential risk factors for different outcomes.
对于多节段（≥3）脊髓型颈椎病（MCSM），选择前路手术还是后路手术仍存在争议。本研究对采用ROI-C椎间融合器的颈椎前路椎间盘切除融合术（ACDF）和椎板成形术进行比较，以确定治疗MCSM的更佳方法。
2012年至2017年期间，57例患者接受了ROI-C椎间融合器ACDF或椎板成形术（LMP）治疗。比较两组的临床和影像学结果。
共有24例患者接受了ROI-C椎间融合器ACDF（ACDF组），33例患者接受了LMP（LMP组）。对他们进行研究，中位随访时间为22个月。ACDF组术中失血量较少（136.7±60.8 vs. 316.7±139.6 mL，P<0.001），住院时间较短（7.8±1.6 vs. 9.9±3.3天，P<0.01）。日本骨科协会评分显示，ACDF和LMP的改善情况相似（恢复率，55.3±19.2% vs. 58.9±18.1%，P>0.05）。术前占位率和JOA评分显著影响手术结果（P<0.01）。ACDF组的颈椎前凸、节段性颈椎前凸和T1斜率均更大。ACDF组颈椎活动度下降10.6°，LMP组下降4.8°（P=0.01）。两组并发症发生率无显著差异。
对于MCSM患者，采用ROI-C椎间融合器的ACDF与LMP具有相似的临床疗效。使用ACDF时，失血量更少，住院时间更短，矢状面平衡得到改善。然而，ACDF术后活动度下降幅度更大。术前占位率和日本骨科协会评分是不同预后的潜在危险因素。
