Bone and Joint Center, Department of Orthopedics, Henry Ford Health System, Detroit, Michigan, United States of America.
School of Medicine, Wayne State University, Detroit, Michigan, United States of America.
PLoS One. 2020 Aug 11;15(8):e0237350. doi: 10.1371/journal.pone.0237350. eCollection 2020.
To compare changes in foraminal motion at two time points post-surgery between artificial disc replacement (ADR) and anterior cervical discectomy and fusion (ACDF).
Eight ACDF and 6 ADR patients (all single-level C5-6) were tested at 2 years (T1) and 6.5 years (T2) post-surgery. The minimum foraminal height (FH.Min) and width (FW.Min) achieved during neck axial rotation and extension, and the range of these dimensions during motion (FH.Rn and FW.Rn, respectively) were measured using a biplane dynamic x-ray system, CT imaging and model-based tracking while patients performed neck axial rotation and extension tasks. Two-way mixed ANOVA was employed for analysis.
In neck extension, significant interactions were found between year post-surgery and type of surgery for FW.Rn at C5-6 (p<0.006) and C6-7 (p<0.005), and for FH.Rn at C6-7 (p<0.01). Post-hoc analysis indicated decreases over time in FW.Rn for ACDF (p<0.01) and increases in FH.Rn for ADR (p<0.03) at the C6-7 adjacent level. At index level, FW.Rn was comparable between ACDF and ADR at T1, but was smaller for ACDF than for ADR at T2 (p<0.002). In axial rotation, differences were found between T1 and T2 but did not depend on type of surgery (p>0.7).
Changes were observed in the range of foraminal geometry at adjacent levels from 2 years to 6.5 years post-surgery that were different between ACDF and ADR for neck extension. These changes are contrary to the notion that motion at adjacent levels continue to increase following ACDF as compared to ADR over the long term.
比较人工椎间盘置换术（ADR）与颈椎前路椎间盘切除融合术（ACDF）后两个时间点椎间孔运动的变化。
8 例 ACDF 和 6 例 ADR 患者（均为单节段 C5-6）分别在术后 2 年（T1）和 6.5 年（T2）进行测试。使用双平面动态 X 射线系统、CT 成像和基于模型的跟踪技术，测量患者进行颈椎轴向旋转和伸展时椎间孔的最小高度（FH.Min）和最小宽度（FW.Min），以及运动过程中这些尺寸的范围（FH.Rn 和 FW.Rn）。采用双向混合方差分析进行分析。
在颈椎伸展时，手术类型和术后时间之间存在显著的相互作用，对 C5-6（p<0.006）和 C6-7（p<0.005）的 FW.Rn 以及 C6-7 的 FH.Rn （p<0.01）有影响。事后分析表明，ACDF 组 FW.Rn 随时间的推移而减少（p<0.01），ADR 组 FH.Rn 增加（p<0.03）。在索引水平，ACDF 和 ADR 在 T1 时的 FW.Rn 相当，但在 T2 时 ACDF 的 FW.Rn 小于 ADR（p<0.002）。在颈椎旋转时，T1 和 T2 之间存在差异，但与手术类型无关（p>0.7）。
在颈椎伸展时，术后 2 年至 6.5 年，相邻节段椎间孔形态的范围发生了变化，ACDF 和 ADR 之间存在差异。这些变化与 ACDF 后相邻节段的运动随着时间的推移继续增加的观点相反，而与 ADR 相比，ACDF 在长期内会增加。
