Grasso Giovanni, Sallì Marcello, Torregrossa Fabio
Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics, Palermo, Italy.
Department of Neurosensory and Motor Surgery, University of Palermo, Palermo, Italy.
World Neurosurg. 2020 Aug;140:527-533. doi: 10.1016/j.wneu.2020.03.097.
Patient satisfaction is becoming an increasing factor worthy of consideration when evaluating the surgical quality. The correlation between patient satisfaction and surgical outcomes 5 years after cervical hybrid surgery (HS), which incorporates anterior cervical decompression and fusion and cervical disk arthroplasty techniques in multilevel cervical degenerative disk disease, has not been evaluated.
The aim of this study was firstly to analyze prospectively collected data from a sample of patients (n = 50) treated with cervical HS for selected cases of radiculopathy and myelopathy in order to evaluate pain levels of patients, using the Neck and Arm Pain scale as an expression of visual analog scale. Secondly, we aimed to evaluate health-related quality of life, via the short-form 36, Neck Disability Index, and Japanese Orthopedic Association score. Patients were followed up for more than 5 years. Intraoperative parameters, clinical features, and outcome scores were recorded. Radiologic investigations including disk height and changes in adjacent disk spaces were assessed.
Clinical improvements were observed in all outcomes; significant improvements on the Neck Disability Index, visual analog scale, short-form 36, and Japanese Orthopedic Association scores were maintained at 5 years (P < 0.05). The mean disk height resulted restored in all the cases. Temporary dysphagia was rarely observed (3%). No surgery for adjacent-level disease was required. There was no significant difference in the outcomes between radiculopathy and myelopathy groups (P > 0.05).
HS is an effective and safe procedure for the treatment of multilevel cervical degenerative disk disease. Such a surgical construct offers postoperative improvement on pain levels and health-related quality of life.
在评估手术质量时，患者满意度正成为一个越来越值得考虑的因素。颈椎混合手术（HS）结合了前路颈椎减压融合术和颈椎间盘置换术，用于治疗多节段颈椎退行性椎间盘疾病，目前尚未评估该手术后5年患者满意度与手术效果之间的相关性。
本研究的目的，首先是对前瞻性收集的50例因神经根病和脊髓病接受颈椎HS治疗的患者样本数据进行分析，以便使用颈肩痛量表作为视觉模拟量表的一种表达方式来评估患者的疼痛程度。其次，我们旨在通过简短健康调查问卷36项、颈部功能障碍指数和日本矫形外科学会评分来评估健康相关生活质量。对患者进行了5年以上的随访。记录术中参数、临床特征和结果评分。评估包括椎间盘高度和相邻椎间盘间隙变化在内的影像学检查结果。
所有结果均观察到临床改善；5年时颈部功能障碍指数、视觉模拟量表、简短健康调查问卷36项和日本矫形外科学会评分均保持显著改善（P<0.05）。所有病例的平均椎间盘高度均恢复。很少观察到暂时性吞咽困难（3%）。无需对相邻节段疾病进行手术。神经根病组和脊髓病组之间的结果无显著差异（P>0.05）。
HS是治疗多节段颈椎退行性椎间盘疾病的一种有效且安全的手术方法。这种手术方式能使术后疼痛程度和健康相关生活质量得到改善。
