Chang Chao-Jui, Liu Yuan-Fu, Hsiao Yu-Meng, Huang Yi-Hung, Liu Keng-Chang, Lin Ruey-Mo, Lin Cheng-Li
1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.
2Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.
J Neurosurg Spine. 2022 Apr 22;37(4):569-578. doi: 10.3171/2022.2.SPINE211500. Print 2022 Oct 1.
OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) has long been regarded as a gold standard in the treatment of cervical myelopathy. Subsequently, cervical artificial disc replacement (c-ADR) was developed and provides the advantage of motion preservation at the level of the intervertebral disc surgical site, which may also reduce stress at adjacent levels. The goal of this study was to compare clinical and functional outcomes in patients undergoing ACDF with those in patients undergoing c-ADR for cervical spondylotic myelopathy (CSM). METHODS: A systematic literature review and meta-analysis were performed using the Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from database inception to November 21, 2021. The authors compared Neck Disability Index (NDI), SF-36, and Japanese Orthopaedic Association (JOA) scores; complication rates; and reoperation rates for these two surgical procedures in CSM patients. The Mantel-Haenszel method and variance-weighted means were used to analyze outcomes after identifying articles that met study inclusion criteria. RESULTS: More surgical time was consumed in the c-ADR surgery (p = 0.04). Shorter hospital stays were noted in patients who had undergone c-ADR (p = 0.04). Patients who had undergone c-ADR tended to have better NDI scores (p = 0.02) and SF-36 scores (p = 0.001). Comparable outcomes in terms of JOA scores (p = 0.24) and neurological success rate (p = 0.12) were noted after the surgery. There was no significant between-group difference in the overall complication rates (c-ADR: 18% vs ACDF: 25%, p = 0.17). However, patients in the ACDF group had a higher reoperation rate than patients in the c-ADR group (4.6% vs 1.5%, p = 0.02). CONCLUSIONS: At the midterm follow-up after treatment of CSM, better functional outcomes as reflected by NDI and SF-36 scores were noted in the c-ADR group than those in the ACDF group. c-ADR had the advantage of retaining range of motion at the level of the intervertebral disc surgical site without causing more complications. A large sample size with long-term follow-up studies may be required to confirm these findings in the future.
目的：长期以来，颈椎前路椎间盘切除融合术（ACDF）一直被视为治疗脊髓型颈椎病的金标准。随后，颈椎人工椎间盘置换术（c-ADR）得以发展，它具有在椎间盘手术部位保留活动度的优势，这也可能减轻相邻节段的应力。本研究的目的是比较接受ACDF治疗的患者与接受c-ADR治疗的脊髓型颈椎病（CSM）患者的临床和功能结局。 方法：使用Embase、PubMed和Cochrane对照试验中央注册库数据库，从建库至2021年11月21日进行系统的文献综述和荟萃分析。作者比较了这两种手术方法在CSM患者中的颈部功能障碍指数（NDI）、SF-36和日本骨科协会（JOA）评分；并发症发生率；以及再次手术率。在确定符合研究纳入标准的文章后，采用Mantel-Haenszel法和方差加权均值分析结局。 结果：c-ADR手术耗时更长（p = 0.04）。接受c-ADR治疗的患者住院时间更短（p = 0.04）。接受c-ADR治疗的患者NDI评分（p = 0.02）和SF-36评分（p = 0.001）往往更好。术后在JOA评分（p = 0.24）和神经功能成功率（p = 0.12）方面观察到类似的结果。总体并发症发生率在组间无显著差异（c-ADR：18% vs ACDF：25%，p = 0.17）。然而，ACDF组患者的再次手术率高于c-ADR组（4.6% vs 1.5%，p = 0.02）。 结论：在CSM治疗后的中期随访中发现，c-ADR组的NDI和SF-36评分所反映的功能结局优于ACDF组。c-ADR具有在椎间盘手术部位保留活动度且不引起更多并发症的优势。未来可能需要大样本量的长期随访研究来证实这些发现。
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