Joo Peter Y, Jayaram Rahul H, McLaughlin William M, Ameri Bijan, Kammien Alexander J, Arnold Paul M, Grauer Jonathan N
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States.
Department of Neurosurgery, Carle Illinois College of Medicine, Champaign, IL, United States.
N Am Spine Soc J. 2022 Mar 24;10:100115. doi: 10.1016/j.xnsj.2022.100115. eCollection 2022 Jun.
BACKGROUND: Multilevel cervical pathology can often be addressed via anterior cervical discectomy and fusion (ACDF) or posterior cervical fusion (PCF). While posterior procedures may be technically easier for four-level pathology, there are advantages and disadvantages to both approaches that make it of interest to compare outcomes. The purpose was to compare perioperative adverse events and long-term cervical reoperation rates of four-level ACDF and PCF. METHODS: The 2010 to Q1 2020 PearlDiver MSpine database was queried. Patients undergoing isolated elective four-level ACDF or PCF were identified (excluding cases performed for trauma, neoplasm, and/or infections) and 1:1 matched based on age, sex, and comorbidities. Ninety-day adverse events were compared with univariate and multivariate analyses. Five-year incidences of subsequent cervical reoperations were also compared. RESULTS: A total of 3,714 patients 1:1 matched for four-level ACDF and PCF performed for degenerative pathologies were identified (1,857 for each of the study groups). On multivariate analysis controlling for age, sex, and comorbidities, PCF was found to have significantly greater odds ratios (OR) for any (OR 2.12), serious (OR 2.31), and minor (OR 1.95) adverse events, as well as for length of stay ≥3 days (OR 1.76), p<0.001 for each. However, PCF had nearly three times lower odds of dysphagia compared to ACDF (OR 0.36, p<0.001). At five years, four-level ACDF cases were found to have significantly higher reoperation rates compared to four-level PCF cases (26.3% vs 18.3%, p<0.001). CONCLUSION: In evaluating four-level cervical cases, compared to anterior approach cases, posterior approach procedures were associated with approximately double the odds of any, serious, and minor adverse events, but around one third the rate of dysphagia and two thirds the rate of five-year reoperations. While the pathology may dictate surgical approach, this data suggests that the choice between four-level anterior versus posterior approach becomes a balance of risks/benefit considerations.
背景：多级颈椎病变通常可通过颈椎前路椎间盘切除融合术（ACDF）或颈椎后路融合术（PCF）来处理。虽然后路手术对于四级病变在技术上可能更容易，但两种方法都有其优缺点，这使得比较两者的结果很有意义。目的是比较四级ACDF和PCF的围手术期不良事件和长期颈椎再次手术率。 方法：查询2010年至2020年第一季度的PearlDiver MSpine数据库。确定接受单纯择期四级ACDF或PCF的患者（排除因创伤、肿瘤和/或感染而进行的病例），并根据年龄、性别和合并症进行1:1匹配。采用单因素和多因素分析比较90天不良事件。还比较了五年内后续颈椎再次手术的发生率。 结果：共确定了3714例因退行性病变进行四级ACDF和PCF且1:1匹配的患者（每个研究组1857例）。在对年龄、性别和合并症进行多因素分析时，发现PCF发生任何（比值比[OR]2.12）、严重（OR 2.31）和轻微（OR 1.95）不良事件以及住院时间≥3天（OR 1.76）的比值比显著更高，每项p<0.001。然而，与ACDF相比，PCF发生吞咽困难的几率低近三倍（OR 0.36，p<0.001）。五年时，发现四级ACDF病例的再次手术率显著高于四级PCF病例（26.3%对18.3%，p<0.001）。 结论：在评估四级颈椎病例时，与前路手术病例相比，后路手术发生任何、严重和轻微不良事件的几率约高一倍，但吞咽困难发生率约为三分之一，五年再次手术率为三分之二。虽然病变情况可能决定手术方式，但这些数据表明，四级前路与后路手术方式的选择成为风险/获益考虑的平衡。
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