Center for Disc Replacement at Texas Back Institute, 6020 W. Parker Rd. #200, Plano, TX, 75093, USA.
Texas Back Institute Research Foundation, Plano, TX, USA.
Eur Spine J. 2020 Nov;29(11):2665-2669. doi: 10.1007/s00586-019-06275-9. Epub 2020 Jan 2.
The purpose was to investigate reasons and their frequency for why total disc replacement (TDR) specialty surgeons performed anterior cervical discectomy and fusion (ACDF) rather than TDR.
A consecutive series of 464 patients undergoing cervical spine surgery during a 5-year period by three TDR specialty surgeons was reviewed. For each ACDF, the reason for not performing TDR was recorded.
TDR was performed in 76.7% of patients (n = 356) and ACDF in 23.3% (n = 108). The most common reason for ACDF versus TDR was anatomical (conditions that may not be adequately addressed with TDR and/or may interfere with device function), which occurred in 64 of 464 patients (13.79%). The second most common reason was insurance (denial/lack of coverage n = 17, 3.23%), and deformity/kyphosis not addressable with TDR was noted in 13 (2.80%). Pseudoarthrosis repair led to ACDF in three patients (0.65%), two did not receive TDR due to osteoporosis (0.43%), and in two others (0.43%) ACDF was undertaken due to high risk of heterotopic ossification. There was one case (0.22%) each of: nickel allergy, trauma with posterior element fracture, TDR removal, multiple prior cervical spine surgeries, concern about artifact on future imaging studies, benign osteoblastic bone, and limitation to adequate surgical approach for TDR. ACDF patients' mean age was significantly greater than TDR patients' (55.3 vs. 46.7 years; p < 0.01). TDR group had significantly more single-level procedures than ACDF (60.8% vs. 43.5%; p < 0.05).
The most common reason for ACDF versus TDR was anatomy that may compromise segmental stability and/or TDR functionality. Older age and greater number of operated levels may be related to anatomical factors, primarily significant osteophytes and severely degenerated facets. These factors, as well as deformity/kyphosis, are more common in older patients and require multi-level treatment. This study found that many patients are good cervical TDR candidates; however, even among TDR specialists, ACDF may be preferred where it is prudent to not take undue risks. These slides can be retrieved under Electronic Supplementary Material.
本研究旨在探讨全椎间盘置换（TDR）专业医生行颈椎前路椎间盘切除融合术（ACDF）而非 TDR 的原因及其频率。
回顾了 3 位 TDR 专业医生在 5 年内对 464 例颈椎手术患者的连续系列病例。记录了每例 ACDF 未行 TDR 的原因。
76.7%（n=356）的患者行 TDR，23.3%（n=108）的患者行 ACDF。行 ACDF 而非 TDR 的最常见原因是解剖学因素（可能无法通过 TDR 充分解决的情况，或可能影响器械功能），464 例患者中有 64 例（13.79%）存在该因素。其次常见的原因是保险（拒绝/无保险 coverage n=17，3.23%），13 例（2.80%）存在 TDR 无法解决的畸形/后凸。3 例（0.65%）因假关节修复而改行 ACDF，2 例（0.43%）因骨质疏松未行 TDR，2 例（0.43%）因异位骨化风险高而行 ACDF。各有 1 例（0.22%）因以下原因改行 ACDF：镍过敏、伴后结构骨折的创伤、TDR 取出、多次颈椎前路手术、对未来影像学研究存在伪影的担忧、良性成骨细胞瘤、以及 TDR 手术入路受限。ACDF 患者的平均年龄显著大于 TDR 患者（55.3 岁比 46.7 岁；p<0.01）。TDR 组的单节段手术显著多于 ACDF 组（60.8%比 43.5%；p<0.05）。
与 TDR 相比，行 ACDF 的最常见原因是可能导致节段不稳定和/或 TDR 功能障碍的解剖学因素。年龄较大和手术节段较多可能与解剖学因素有关，主要是明显的骨赘和严重的关节突关节退变。这些因素，以及畸形/后凸，在老年患者中更为常见，需要多节段治疗。本研究发现，许多患者是良好的颈椎 TDR 候选者；然而，即使在 TDR 专家中，在不冒不必要风险的情况下，ACDF 也可能是首选。这些幻灯片可以在电子补充材料中检索到。
