前路颈椎椎体次全切除融合术与前路颈椎间盘切除融合术治疗多节段脊髓型颈椎病的疗效比较：来自国家注册登记研究的启示。
Anterior Cervical Corpectomy and Fusion Versus Anterior Cervical Discectomy and Fusion for Treatment of Multilevel Cervical Spondylotic Myelopathy: Insights from a National Registry.
机构信息
Mayo Clinic Neuro-Informatics Lab, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
World Neurosurg. 2019 Dec;132:e852-e861. doi: 10.1016/j.wneu.2019.07.220. Epub 2019 Aug 5.
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) is the most common procedure for single-level cervical spondylotic myelopathy (CSM); however, for multilevel CSM, some patients may also undergo anterior cervical corpectomy and fusion (ACCF). We sought to assess differences in clinical outcomes between patients undergoing ACDF and those undergoing ACCF for multilevel CSM.
METHODS
The National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2017 to identify patients diagnosed with CSM undergoing 1- or 2-level ACCF and 2- or 3-level ACDF. Three-to-one propensity scoring was used to match patients undergoing 1-level ACCF to those undergoing 2-level ACDF. Multivariable regression was performed to compare 30-day clinical outcomes between ACCF and ACDF recipients.
RESULTS
A total of 3708 patients undergoing 1-level ACCF (n = 729; 18.7%) or 2-level ACDF (n = 3179; 81.3%) were identified. On multivariable regression, 1-level ACCF was associated with significantly longer length of stay (coefficient, 0.79; 95% confidence interval [CI], 0.46-1.11; P < 0.001), longer operative time (coefficient, 19.01; 95% CI, 11.94-26.08; P < 0.001), decreased odds of readmissions (odds ratio [OR], 0.95; 95% CI, 0.91-0.99; P = 0.018), and increased odds of complications (OR, 1.02; 95% CI, 1.00-1.04; P = 0.028) compared with those undergoing 2-level ACDF. A total of 939 patients undergoing either 2-level ACCF (n = 348; 37.1%) or 3-level ACDF (n = 591; 62.9%) were identified. On multivariable regression, 2-level ACCF was associated with significantly longer length of stay (coefficient, 1.17; 95% CI, 0.55-1.79; P < 0.001) and increased risk of complications (OR, 1.05; 95% CI, 1.01-1.08; P = 0.004) compared with 3-level ACDF.
CONCLUSIONS
Our analyses indicate that ACCF may be associated with worse clinical outcomes than ACDF following multilevel treatment for CSM.
背景
颈椎前路椎间盘切除术和融合术（ACDF）是治疗单节段颈椎病脊髓病（CSM）最常用的方法；然而，对于多节段 CSM，一些患者也可能接受颈椎前路椎体次全切除术和融合术（ACCF）。我们旨在评估多节段 CSM 患者接受 ACDF 和 ACCF 治疗的临床结果差异。
方法
从 2007 年到 2017 年，我们对国家手术质量改进计划（NSQIP）数据库进行了查询，以确定诊断为 CSM 并接受 1 或 2 级 ACCF 和 2 或 3 级 ACDF 的患者。使用三比一倾向评分匹配接受 1 级 ACCF 的患者与接受 2 级 ACDF 的患者。采用多变量回归比较 ACCF 和 ACDF 受者的 30 天临床结果。
结果
共确定了 3708 例接受 1 级 ACCF（n=729；18.7%）或 2 级 ACDF（n=3179；81.3%）的患者。多变量回归显示，1 级 ACCF 与住院时间延长（系数，0.79；95%置信区间[CI]，0.46-1.11；P<0.001）、手术时间延长（系数，19.01；95% CI，11.94-26.08；P<0.001）、再入院几率降低（比值比[OR]，0.95；95% CI，0.91-0.99；P=0.018）和并发症几率增加（OR，1.02；95% CI，1.00-1.04；P=0.028）相关，与接受 2 级 ACDF 的患者相比。共确定了 939 例接受 2 级 ACCF（n=348；37.1%）或 3 级 ACDF（n=591；62.9%）的患者。多变量回归显示，2 级 ACCF 与住院时间延长（系数，1.17；95% CI，0.55-1.79；P<0.001）和并发症风险增加（OR，1.05；95% CI，1.01-1.08；P=0.004）相关，与 3 级 ACDF 相比。
结论
我们的分析表明，在多节段 CSM 的治疗中，与 ACDF 相比，ACCF 可能与更差的临床结果相关。
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