Brotzki Christopher, Petridis Athanasios K, Steiger Hans-Jakob, Bostelmann Tamara, Bostelmann Richard
Department of Neurosurgery, Faculty of Medicine, University Clinic Düsseldorf, Düsseldorf, Germany.
Department of Neurosurgery, Faculty of Medicine, University Clinic Düsseldorf, Düsseldorf, Germany.
World Neurosurg. 2020 Aug;140:e112-e120. doi: 10.1016/j.wneu.2020.04.182. Epub 2020 May 1.
Conventional surgical treatment of multilevel cervical disc disease is based on anterior cervical discectomy and fusion (ACDF). However, fusion alters the biomechanics of the spine, potentially resulting in accelerated adjacent segment degeneration. To improve clinical outcomes, hybrid surgery, combining cervical disc arthroplasty with fusion, has been developed. Cervical total disc replacement (TDR) has been shown to keep the motion of adjacent segment, and a dynamic cervical implant (DCI) was shown to provide cervical dynamic stability under nonfusion. However, curative and unwanted side effects of the new therapy options TDR and DCI for treating multilevel cervical degenerative disc disease are still unknown.
This analysis is based on 88 patients treated for multilevel cervical degenerative disc disease with ACDF only (56 patients), DCI hybrid (17 patients), and TDR hybrid (15 patients) between June 2008 and November 2015. The mean follow-up was 19.5 months. Visual analog scale (VAS), Neck Disability Index, and quality-of-life measurements were assessed via questionnaires.
The VAS scores decreased significantly in all 3 groups (P < 0.001), but the TDR group showed the greatest reduction in VAS score compared with ACDF and DCI (both P < 0.05). The overall range of motion (ROM) and the segmental ROM at the treated levels showed significant decreases in all 3 groups. Although there was no difference in the overall ROM at final follow-up among the operatively treated groups, the ROM of the treated segment was lowest in the ACDF group (P = 0.002). In terms of heterotopic ossification, patients undergoing TDR showed the best prognosis.
These results indicate that both TDR hybrid and DCI hybrid are effective and safe procedures for the treatment of multilevel degenerative disc disease. However, there is no definitive evidence that DCI or TDR arthroplasty lead to better intermediate-term results than ACDF over an average observation time of 19.5 months.
多节段颈椎间盘疾病的传统手术治疗基于颈椎前路椎间盘切除融合术（ACDF）。然而，融合改变了脊柱的生物力学，可能导致相邻节段加速退变。为改善临床疗效，已开发出将颈椎间盘置换术与融合术相结合的混合手术。颈椎全椎间盘置换术（TDR）已被证明可保持相邻节段的活动度，动态颈椎植入物（DCI）被证明可在非融合状态下提供颈椎动态稳定性。然而，TDR和DCI这两种新的治疗多节段颈椎退行性椎间盘疾病的疗法的疗效和不良副作用仍不明确。
本分析基于2008年6月至2015年11月期间接受治疗的88例多节段颈椎退行性椎间盘疾病患者，其中仅接受ACDF治疗的有56例，接受DCI混合手术的有17例，接受TDR混合手术的有15例。平均随访时间为19.5个月。通过问卷调查评估视觉模拟量表（VAS）、颈部功能障碍指数和生活质量测量结果。
所有3组的VAS评分均显著降低（P < 0.001），但与ACDF组和DCI组相比，TDR组的VAS评分降低幅度最大（均P < 0.05）。所有3组治疗节段的总体活动度（ROM）和节段性ROM均显著降低。尽管在最终随访时手术治疗组之间的总体ROM无差异，但ACDF组治疗节段的ROM最低（P = 0.002）。在异位骨化方面，接受TDR治疗的患者预后最佳。
这些结果表明，TDR混合手术和DCI混合手术都是治疗多节段退行性椎间盘疾病的有效且安全的方法。然而，在平均19.5个月的观察期内，没有确凿证据表明DCI或TDR置换术比ACDF能带来更好的中期疗效。
