Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Weill Cornell Medical College, New York, NY, USA.
Spine J. 2022 Sep;22(9):1481-1489. doi: 10.1016/j.spinee.2022.04.001. Epub 2022 Apr 8.
Although anterior cervical discectomy and fusion is believed to positively impact a patient's radicular symptoms as well as axial neck pain, the outcomes of cervical disc replacement (CDR) with regards to neck pain specifically have not been established.
Primary: to assess clinical improvement following CDR in patients with neck pain greater than arm pain. Secondary: to compare the clinical outcomes between patients undergoing CDR for predominant neck pain (pNP), predominant arm pain (pAP), and equal neck and arm pain (ENAP).
Retrospective review of prospectively collected data.
Patients who had undergone one- or two-level CDR for the treatment of degenerative cervical pathology and had a minimum of 6-month follow-up were included and stratified into three cohorts based on their predominant location of pain: pNP, pAP, and ENAP.
Patient-reported outcomes: Neck Disability Index (NDI), Visual Analog Scale (VAS) neck and arm, Short Form 12-Item Physical Health Score (SF12-PHS), Short Form 12-Item Mental Health Score (SF12-MHS), minimal clinically important difference (MCID).
Changes in Patient-reported outcomes from preoperative values to early (<6 months) and late (≥6 months) postoperative timepoints were analyzed within each of the three groups. The percentage of patients achieving MCID was also evaluated.
One hundred twenty-five patients (52 pNP, 30 pAP, 43 ENAP) were included. The pNP cohort demonstrated significant improvements in early and late NDI and VAS-Neck, early SF-12 MCS, and late SF-12 PCS. The pAP and ENAP cohorts demonstrated significant improvements in all PROMs, including NDI, VAS-Neck, VAS-Arm, SF-12 PCS, and SF-12 MCS, at both the early and late timepoints. No statistically significant differences were found in the MCID achievement rates for NDI, VAS-Neck, SF-12 PCS, and SF-12 MCS at the late timepoint amongst the three groups.
CDR leads to comparable improvement in neck pain and disability in patients presenting with neck pain greater than arm pain and meeting specific clinical and radiographic criteria.
尽管颈椎前路椎间盘切除融合术被认为可以积极改善患者神经根症状和颈痛，但颈椎间盘置换术（CDR）对颈痛的疗效尚未确定。
主要目的：评估颈痛重于臂痛的患者行 CDR 后的临床改善。次要目的：比较主要为颈痛（pNP）、主要为臂痛（pAP）和颈痛与臂痛相等（ENAP）的患者行 CDR 的临床结果。
前瞻性收集数据的回顾性研究。
纳入接受单节段或双节段 CDR 治疗退行性颈椎病变且随访至少 6 个月的患者，并根据其主要疼痛部位分为三组：pNP、pAP 和 ENAP。
患者报告的结果：颈椎残疾指数（NDI）、颈部和手臂视觉模拟量表（VAS）、健康调查简表 12 项（SF-12）生理健康评分（SF12-PHS）、SF-12 心理健康评分（SF12-MHS）、最小临床重要差异（MCID）。
分析每组患者的术前至术后早期（<6 个月）和晚期（≥6 个月）的患者报告结果的变化。还评估了达到 MCID 的患者比例。
共纳入 125 例患者（52 例 pNP、30 例 pAP、43 例 ENAP）。pNP 组在早期和晚期的 NDI 和 VAS 颈痛、早期 SF-12 MCS 和晚期 SF-12 PCS 方面均有显著改善。pAP 和 ENAP 组在所有 PROM 方面均有显著改善，包括 NDI、VAS 颈痛、VAS 手臂痛、SF-12 PCS 和 SF-12 MCS，在早期和晚期均有显著改善。在晚期，三组之间在 NDI、VAS 颈痛、SF-12 PCS 和 SF-12 MCS 的 MCID 达标率方面无统计学差异。
对于符合特定临床和影像学标准的颈痛重于臂痛的患者，CDR 可导致颈痛和残疾的改善程度相当。
