Karamian Brian A, Levy Hannah A, Canseco Jose A, Goyal Dhruv K C, Divi Srikanth N, Lee Joseph K, Kurd Mark F, Rihn Jeffrey A, Hilibrand Alan S, Kepler Christopher K, Vaccaro Alexander R, Schroeder Gregory D
Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Global Spine J. 2023 Apr;13(3):689-695. doi: 10.1177/21925682211004244. Epub 2021 Mar 24.
Retrospective cohort study.
The aim of this study is to determine if there is a correlation between the amount of facet distraction and postoperative patient-reported outcomes after ACDF.
A retrospective cohort analysis of patients undergoing 1 to 3 level ACDF for degenerative pathologies at a single academic center was performed. Each patient received upright, lateral cervical spine x-rays at the immediate postoperative time point from which interfacet distance (facet distraction) was measured. Patient-reported outcome measures including NDI, PCS-12, MCS-12, VAS Neck, and VAS Arm pain scores were obtained preoperatively and at short-term (<3 months) and long-term (>1 year) follow-up. Receiver operating curves were generated to evaluate the possibility of a critical interfacet distraction distance. Univariate and multivariate analysis were performed to compare outcomes between groups based on the degree of facet distraction.
A total of 229 patients met the inclusion criteria. Receiver operating curves failed to yield a critical interfacet distraction distance associated with worse post-operative outcomes. Patients were instead grouped based on facet distraction distance below and above the third quartile (0.8mm-2.0 mm, 2.0mm-3.7 mm), with 173 and 56 patients in each respective group. Univariate analysis did not detect any statistically significant differences in outcome measures, recovery ratio, or % MCID achievement at short- and long-term follow-up between groups. Multivariate analysis also failed to demonstrate any significant differences between the facet distraction groups.
Increased interfacet distance did not correlate with increased neck pain or disability after an ACDF.
回顾性队列研究。
本研究旨在确定小关节撑开量与ACDF术后患者报告的结局之间是否存在相关性。
对在单一学术中心因退行性病变接受1至3节段ACDF的患者进行回顾性队列分析。每位患者在术后即刻接受颈椎正侧位X线检查，测量椎间小关节距离（小关节撑开量）。术前以及短期（<3个月）和长期（>1年）随访时获取患者报告的结局指标，包括NDI、PCS-12、MCS-12、颈部视觉模拟评分（VAS Neck）和手臂疼痛视觉模拟评分（VAS Arm）。生成受试者工作曲线以评估临界椎间小关节撑开距离的可能性。基于小关节撑开程度进行单因素和多因素分析，比较组间结局。
共有229例患者符合纳入标准。受试者工作曲线未能得出与术后较差结局相关的临界椎间小关节撑开距离。相反，根据小关节撑开距离是否低于和高于第三四分位数（0.8mm - 2.0mm，2.0mm - 3.7mm）对患者进行分组，每组分别有173例和56例患者。单因素分析未发现在短期和长期随访时，组间在结局指标、恢复率或达到最小临床重要差异百分比方面存在任何统计学显著差异。多因素分析也未能证明小关节撑开组之间存在任何显著差异。
ACDF术后，椎间小关节距离增加与颈部疼痛或残疾增加无关。
