Neurosurgical Clinic, Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, School of Medicine, Palermo, Italy.
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Br J Neurosurg. 2022 Dec;36(6):777-785. doi: 10.1080/02688697.2022.2077309. Epub 2022 May 19.
Patients with cervical spondylosis often present with concurrent 'atypical symptoms' of unknown etiology that have been associated with cervical spondylotic disease, including dizziness, headache, nausea, tinnitus, blurred vision, palpitations, and memory and gastrointestinal disturbances. Few studies have addressed whether surgical intervention to treat classic symptoms of cervical spondylosis can also effectively alleviate atypical symptoms. Accordingly, the purpose of this study is to compare the ability of cervical arthroplasty (CA) and anterior cervical discectomy and fusion (ACDF) to alleviate atypical symptoms associated with cervical spondylosis.
A retrospective analysis of 140 patients with cervical spondylosis and associated atypical symptoms was performed. Atypical symptoms were defined vertigo, headache, nausea and vomiting, tinnitus, blur vision, palpitation, hypomnesia, and gastroenteric disturbances not otherwise explained by medical comorbidities. Seventy-eight patients (55.7%) underwent ACDF and 62 (44.3%) patients underwent CA. Demographics, surgical characteristics, patient reported outcome measures (PROMs), radiographs, complication rates, and resolution in atypical symptoms were recorded and compared between groups. Atypical symptoms were assessed using a 20-point system. All the patients had a minimum of five years follow-up.
VAS, SF-36, JOA, and NDI scores improved significantly in all the patients ( < 0.001). At the last follow-up, the fusion rate was 97% in the ACDF group. Atypical symptoms improved in both groups ( < 0.001), although the ACDF group demonstrated greater improvement in headache and vertigo resolution compared to the CA group ( < 0.0001).
While both ACDF and CA are effective in alleviating atypical symptoms associated with cervical spondylosis, ACDF demonstrated greater improvements in atypical symptoms.
颈椎病患者常伴有病因不明的“非典型症状”，这些症状与颈椎病有关，包括头晕、头痛、恶心、耳鸣、视力模糊、心悸、记忆力和胃肠道紊乱。很少有研究探讨治疗颈椎病典型症状的手术干预是否也能有效缓解非典型症状。因此，本研究旨在比较颈椎人工关节置换术（CA）和前路颈椎间盘切除融合术（ACDF）缓解颈椎病相关非典型症状的能力。
对 140 例颈椎病伴非典型症状的患者进行回顾性分析。非典型症状定义为眩晕、头痛、恶心呕吐、耳鸣、视力模糊、心悸、记忆力减退和胃肠道紊乱，且无法用其他医学合并症来解释。78 例（55.7%）患者行 ACDF，62 例（44.3%）患者行 CA。记录并比较两组患者的一般资料、手术特点、患者报告的结局测量（PROMs）、影像学结果、并发症发生率和非典型症状缓解情况。非典型症状采用 20 分制进行评估。所有患者的随访时间均至少为 5 年。
所有患者的视觉模拟评分（VAS）、SF-36 量表评分、日本骨科协会（JOA）评分和颈椎功能障碍指数（NDI）评分均显著改善（ < 0.001）。在 ACDF 组，末次随访时融合率为 97%。两组患者的非典型症状均有改善（ < 0.001），但 ACDF 组头痛和眩晕缓解的改善程度优于 CA 组（ < 0.0001）。
虽然 ACDF 和 CA 均可有效缓解颈椎病相关的非典型症状，但 ACDF 组在非典型症状方面的改善更为明显。
