单纯前路颈椎间盘切除融合术与椎间融合器加钢板植入融合术的临床及影像学结果比较
Comparison of Clinical and Radiographic Outcomes After Standalone Versus Cage and Plate Constructs for Anterior Cervical Discectomy and Fusion.
作者信息
Fayed Islam, Conte Anthony G, Keating Gregory, Cobourn Kelsey D, Altshuler Marcelle, Makariou Erini, Spitz Steven M, Anaizi Amjad N, Nair M Nathan, Voyadzis Jean-Marc, Sandhu Faheem A
机构信息
MedStar Georgetown University Hospital, Department of Neurosurgery, Washington, DC.
Georgetown University School of Medicine, Washington, DC.
出版信息
Int J Spine Surg. 2021 Jun;15(3):403-412. doi: 10.14444/8060. Epub 2021 May 7.
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) has conventionally been performed using an allograft cage with a plate-and-screw construct. Recently, standalone cages have gained popularity due to theorized decreases in operative time and postoperative dysphagia. Few studies have compared these outcomes. Here, we directly compare the outcomes of plated versus standalone ACDF constructs.
METHODS
A single-center retrospective review of patients undergoing ACDF after June 2011 with at least 6 months of follow up was conducted. Clinical outcomes were analyzed and compared between standalone and plated constructs. Multivariate regression analysis of the primary outcome, need for revision surgery, as well as several secondary outcomes, procedure duration, estimated blood loss (EBL), length of hospital stay, disposition, and incidence of dysphagia, hoarseness, or surgical site infection, was completed.
RESULTS
A total of 321 patients underwent ACDF and met inclusion-exclusion criteria, with mean follow-up duration of 20 months. Forty-six (14.3%) patients received standalone constructs, while 275 (85.7%) received plated constructs. Fourteen (4.4%) total revisions were necessary, 4 in the standalone group and 10 in the plated group, yielding revision rates of 8.7% and 3.6%, respectively ( = .125). Mean EBL was 98 mL in the standalone group and 63 mL in the plated group ( = .001). Mean procedure duration was 147 minutes in the standalone group and 151 minutes in the plated group ( = .800). Mean hospital stay was 3.6 days in the standalone group and 2.5 days in the plated group ( = .270). There was no significant difference in incidence of dysphagia ( = .700) or hoarseness ( = .700).
CONCLUSIONS
Standalone ACDF demonstrates higher, but not statistically significant, revision rates than plate-and-screw constructs, without the hypothesized decreased incidence of dysphagia or hoarseness and without decreased procedure duration or EBL. Surgeons may consider limiting use of these constructs to cases of adjacent segment disease. Larger studies with longer follow up are necessary to make more definitive conclusions.
LEVEL OF EVIDENCE
CLINICAL RELEVANCE
This study will help spine surgeons decide between using standalone or cage-and-plate constructs for ACDF.
背景
颈椎前路椎间盘切除融合术（ACDF）传统上是使用带有钢板螺钉结构的同种异体骨融合器进行的。最近，独立融合器因其理论上可缩短手术时间和减少术后吞咽困难而受到欢迎。很少有研究比较这些结果。在此，我们直接比较带钢板与独立ACDF结构的手术效果。
方法
对2011年6月后接受ACDF且随访至少6个月的患者进行单中心回顾性研究。分析并比较独立结构组和带钢板结构组的临床结果。对主要结果（翻修手术需求）以及几个次要结果（手术时间、估计失血量（EBL）、住院时间、出院情况以及吞咽困难、声音嘶哑或手术部位感染的发生率）进行多因素回归分析。
结果
共有321例患者接受了ACDF并符合纳入排除标准，平均随访时间为20个月。46例（14.3%）患者使用独立融合器，275例（85.7%）患者使用带钢板融合器。总共需要进行14例（4.4%）翻修手术，独立融合器组4例，带钢板融合器组10例，翻修率分别为8.7%和3.6%（P = 0.125）。独立融合器组的平均EBL为98 mL，带钢板融合器组为63 mL（P = 0.001）。独立融合器组的平均手术时间为147分钟，带钢板融合器组为151分钟（P = 0.800）。独立融合器组的平均住院时间为3.6天，带钢板融合器组为2.5天（P = 0.270）。吞咽困难（P = 0.700）或声音嘶哑（P = 0.700）的发生率无显著差异。
结论
独立ACDF的翻修率高于带钢板螺钉结构，但无统计学意义，且未出现吞咽困难或声音嘶哑发生率降低以及手术时间或EBL减少的情况。外科医生可考虑将这些结构的使用限制于相邻节段疾病的病例。需要进行更大规模、更长随访时间的研究以得出更明确的结论。
证据等级
4级。
临床意义
本研究将有助于脊柱外科医生在独立融合器或带钢板融合器用于ACDF时做出决策。
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