Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
Clin Neurol Neurosurg. 2021 Mar;202:106493. doi: 10.1016/j.clineuro.2021.106493. Epub 2021 Jan 18.
Whether and when cervical disc arthroplasty (CDA) could be indicated for preoperative cervical spine kyphosis is unclear. The purpose of the study was to compare the clinical and radiological outcomes of single-level CDA and single-level anterior cervical discectomy and fusion (ACDF) in the patient with preoperative reversible kyphosis.
From 2014-2018, patients who underwent single-level CDA and single-level ACDF were consecutively reviewed. The Japanese Orthopedic Association score, Neck Disability Index and VAS were used to evaluate clinical outcomes. Range of motion (ROM), C2-7 Cobb angle, functional spinal unit (FSU) angle, and heterotopic ossification (HO) were assessed.
Thirty-eight CDA patients (a mean follow-up of 39.8 months) and 42 ACDF patients (37.6 months) with preoperative reversible kyphosis were included. Both groups had significant improvements in clinical outcomes, without statistically significant differences. Before surgery, there was no significant difference in cervical alignment and ROM between groups. After surgery, both groups had a significant increase in C2-7 angle and FSU without significant inter-group differences. At the last follow-up, CDA group consisted of 5 cases of lordosis, 11 cases of kyphosis and 22 cases of straight spine, while the corresponding case number in ACDF group was 4, 12 and 26 (P = 0.866). The C2-7 ROM was preserved in both groups. The segmental ROM of CDA group decreased mildly from 8.3° preoperatively to 5.1° finally, whereas the segmental ROM of ACDF group decreased significantly to nearly zero. 60.5 % (23/38) patients in CDA group developed HO with 9 levels of grade Ⅲ and 3 levels of grade Ⅳ.
For the patients with single-level disc degenerative disease and preoperative reversible kyphosis, both CDA and ACDF achieved satisfactory and comparable clinical results. CDA was non-inferior to ACDF regarding the radiological outcomes of cervical alignment. Patients in CDA group had a relatively high incidence of HO formation.
颈椎间盘置换术（CDA）是否及何时可用于术前颈椎后凸尚不清楚。本研究的目的是比较术前可复性后凸患者单节段 CDA 和单节段前路颈椎间盘切除融合术（ACDF）的临床和影像学结果。
2014 年至 2018 年，连续回顾了接受单节段 CDA 和单节段 ACDF 的患者。采用日本矫形协会评分、颈部残疾指数和视觉模拟评分评估临床结果。评估活动范围（ROM）、C2-7 Cobb 角、功能脊柱单位（FSU）角和异位骨化（HO）。
38 例 CDA 患者（平均随访 39.8 个月）和 42 例 ACDF 患者（37.6 个月）术前存在可复性后凸。两组患者的临床结果均有显著改善，无统计学差异。术前颈椎排列和 ROM 两组间无显著差异。术后两组 C2-7 角和 FSU 均显著增加，组间无显著差异。末次随访时，CDA 组 5 例为前凸，11 例为后凸，22 例为直脊柱，而 ACDF 组相应的病例数为 4、12 和 26（P=0.866）。两组 C2-7 ROM 均保留。CDA 组的节段 ROM 轻度下降，从术前的 8.3°降至最终的 5.1°，而 ACDF 组的节段 ROM 显著下降至接近 0。CDA 组 60.5%（23/38）患者发生 HO，9 级 3 级，3 级 4 级。
对于单节段椎间盘退行性疾病和术前可复性后凸的患者，CDA 和 ACDF 均取得了满意且可比的临床效果。CDA 在颈椎对线的影像学结果方面不劣于 ACDF。CDA 组患者 HO 形成的发生率相对较高。
