Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
Baxter Regional Neurosurgery & Spine Clinic, Mountain Home, Arkansas, USA.
World Neurosurg. 2022 Jul;163:e363-e376. doi: 10.1016/j.wneu.2022.03.119. Epub 2022 Apr 1.
There are limited patient-reported outcome measure (PROM) data on 4-level and 5-level anterior cervical discectomy and fusion (ACDF). The largest series to date solely focused on complications. This retrospective series evaluates PROMs after 4-level and 5-level ACDF.
Pertinent data from adult patients treated with a 4-level or 5-level ACDF in 2011-2019 were analyzed. PROMs and minimal clinically important differences (MCIDs) were assessed. Factors associated with favorable and unfavorable outcomes were identified.
There were 34 patients (30 underwent 4-level and 4 underwent 5-level ACDFs) with a mean age of 59.6 years; 55.9% were women. At 3 months, there were significant improvements in PROMs except Short-Form 12-Item Survey (SF-12) mental component subscale, which showed modest improvement. At 12 months, there were significant improvements in PROMs except SF-12 physical component subscale (PCS), which showed moderate improvement. The proportions of patients who met the MCID cutoffs ranged from 35.3% (numeric rating scale [NRS]-neck) to 75% (Veteran RAND 12-Item Survey [VR-12] PCS) at 3 months and 38.2% (NRS-arm) to 65.5% (VR-12 mental component subscale) at 12 months. Shorter symptom duration was associated with significantly reduced postoperative pain and Neck Disability Index scores. Shorter length of stay was associated with significantly improved postoperative functional outcomes. patients undergoing 4-level compared with 5-level ACDF achieved better postoperative PROMs. Shorter procedure duration was associated with improved PROMs at 3 months. No patient returned to the operating room within 30 days. Patients who required reoperation achieved significantly inferior Neck Disability Index, NRS-neck, and SF-12 PCS scores at 3 months.
This study showed satisfactory PROMs up to 12 months after 4-level and 5-level ACDF despite the complication rate. With thorough preoperative planning and meticulous technique, performing this procedure in carefully selected patients may be associated with acceptable PROMs.
目前关于 4 节段和 5 节段颈椎前路椎间盘切除融合术（ACDF）的患者报告结局测量（PROM）数据有限。迄今为止，最大的系列研究仅关注并发症。本回顾性系列研究评估了 4 节段和 5 节段 ACDF 后的 PROM。
分析了 2011 年至 2019 年期间接受 4 节段或 5 节段 ACDF 治疗的成年患者的相关数据。评估了 PROM 和最小临床重要差异（MCID）。确定了与良好和不良结局相关的因素。
34 例患者（30 例行 4 节段 ACDF，4 例行 5 节段 ACDF），平均年龄 59.6 岁；55.9%为女性。3 个月时，PROM 显著改善，除了 36 项简短健康调查（SF-12）精神成分量表外，仅显示适度改善。12 个月时，PROM 显著改善，除了 SF-12 生理成分量表（PCS）外，仅显示中度改善。符合 MCID 截止值的患者比例范围为 35.3%（数字评分量表[NRS]-颈部）至 75%（退伍军人 RAND 12 项调查[VR-12]PCS），3 个月和 38.2%（NRS-手臂）至 65.5%（VR-12 精神成分量表），12 个月。症状持续时间较短与术后疼痛和颈部残疾指数评分显著降低相关。住院时间较短与术后功能结果显著改善相关。与 5 节段 ACDF 相比，4 节段 ACDF 患者术后获得更好的 PROM。手术时间较短与术后 3 个月 PROM 改善相关。无患者在 30 天内返回手术室。需要再次手术的患者在 3 个月时的颈部残疾指数、NRS-颈部和 SF-12 PCS 评分明显较低。
尽管存在并发症发生率，但本研究在 4 节段和 5 节段 ACDF 后 12 个月内仍显示出令人满意的 PROM。通过彻底的术前规划和精细的技术，在精心选择的患者中进行该手术可能与可接受的 PROM 相关。
