Hospital for Special Surgery, New York, New York.
The Kim Barrett Memorial Library, Hospital for Special Surgery, New York, New York.
Spine (Phila Pa 1976). 2019 Oct 1;44(19):E1151-E1158. doi: 10.1097/BRS.0000000000003077.
STUDY DESIGN: Systematic review. OBJECTIVE: To determine the difference in postoperative sagittal alignment when single level cervical radiculopathy or myelopathy is treated with an anterior cervical discectomy and fusion (ACDF) using a structural graft and plate, a stand-alone ACDF, or a total disc arthroplasty (TDR). We also wanted to determine if postoperative sagittal alignment impacted clinical outcomes in this patient population. SUMMARY OF BACKGROUND DATA: Although there are several accepted techniques for interbody reconstruction during single level anterior cervical surgery, little is known on the impact of any of them on segmental and regional sagittal alignment. METHODS: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines of the PubMed, Embase, and Cochrane databases. Only studies which contained pre and postoperative C2-7 Cobb angles as well as Neck Disability Index (NDI) scores following single level traditional ACDF with plate and cage, stand-alone ACDF, or TDR with at least 1 year follow up were included. RESULTS: There were 12 publications that fulfilled the inclusion criteria with a total of 658 patients. Cluster regression analysis showed no difference between treatment arms at each respective time-point or in the overall change in NDI from preoperative to postoperative (P = 0.88). Cluster regression analysis showed no difference between treatment arms at each respective time point or in the overall change in lordosis from pre-op to post-op (P = 0.93). CONCLUSION: This review provides evidence that while NDI scores improved across all devices, there was no significant difference in NDI improvement or C2-7 Cobb angle change between single level traditional ACDF, stand-alone ACDF, or TDR. Although TDR has not been considered a lordosis producing operation, our investigation shows it does not differ significantly in sagittal profile from other cervical fusion techniques. Moreover, we show that the NDI score improved, regardless of device implanted. LEVEL OF EVIDENCE: 1.
研究设计：系统回顾。 目的：确定治疗单节段颈椎病或颈椎脊髓病时，使用结构性移植物和钢板的前路颈椎间盘切除术和融合术（ACDF）、单纯 ACDF 或全椎间盘置换术（TDR）在术后矢状位对线方面的差异。我们还想确定在这一患者群体中，术后矢状位对线是否会影响临床结果。 背景资料概要：虽然前路颈椎手术中存在几种可接受的节段间重建技术，但对于它们中的任何一种对节段和区域矢状位对线的影响，知之甚少。 方法：根据 PubMed、Embase 和 Cochrane 数据库的系统评价和荟萃分析（PRISMA）指南进行文献系统回顾。仅纳入包含术前和术后 C2-7 Cobb 角以及颈痛残疾指数（NDI）评分的研究，这些研究均为单节段传统 ACDF 联合钢板和 cage、单纯 ACDF 或 TDR 治疗，随访时间至少 1 年。 结果：共有 12 篇符合纳入标准的文献，共纳入 658 例患者。聚类回归分析显示，在每个相应的时间点或从术前到术后 NDI 的总体变化方面，治疗组之间没有差异（P=0.88）。聚类回归分析显示，在每个相应的时间点或从术前到术后的前凸总体变化方面，治疗组之间没有差异（P=0.93）。 结论：本综述提供的证据表明，虽然所有器械的 NDI 评分均有所改善，但在单节段传统 ACDF、单纯 ACDF 或 TDR 之间，NDI 改善或 C2-7 Cobb 角变化方面没有显著差异。尽管 TDR 不被认为是一种产生前凸的手术，但我们的研究表明，它在矢状位形态上与其他颈椎融合技术没有显著差异。此外，我们还表明，无论植入何种器械，NDI 评分均得到改善。 证据等级：1 级。
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