Neurosurgery Unit, ASST Fatebenefratelli Sacco, Milan, Italy.
Neurosurgery Unit, Department of Medicine and Surgery, Università degli Studi Milano Bicocca, Milan, Italy.
World Neurosurg. 2022 Sep;165:6-12. doi: 10.1016/j.wneu.2022.06.009. Epub 2022 Jun 7.
Cervical disc diseases have been treated by cervical disc arthroplasty (CDA). Nevertheless, some patients will experience a mobility failure in their cervical prostheses over time because of heterotopic ossification. The aim of this study was to investigate the role of gender in long-term outcomes after CDA.
A retrospective, single-center study of patients who underwent single-level CDA with a BRYAN Cervical Disc prosthesis was performed, including a narrative review about gender differences in both structural and biomechanical features of the cervical spine.
Study patients (14 men, 30 women) had an average follow-up of 9.8 ± 3.2 years. Significant differences emerged between genders for specific items in Neck Disability Index preoperative evaluation, with women reporting worse pain scores (P = 0.05). After stratification by age, we found a higher preoperative overall Neck Disability Index score for female patients <36 years of age (P = 0.03). In an intergender, body mass index-specific comparison, we also found a significant difference in Neck Disability Index preoperative score with normal-weight male patients faring worse than overweight male patients (P = 0.05). At a radiological level, we found a tendency toward a higher heterotopic ossification incidence in male patients (62% in men, 17% in women, P = 0.06). The female cervical spine has distinctive features, including bone structure, muscular action, soft tissue response, and genetic and epigenetic response to osteoarthritis.
The incidence of mobility failure in our series of single-level CDA was lower in female patients. Several gender-specific factors both in static and in dynamic features may play a significant role in spinal pathology and CDA long-term radiological outcome.
颈椎间盘疾病已通过颈椎间盘置换术（CDA）进行治疗。然而，随着时间的推移，由于异位骨化，一些患者的颈椎假体将出现活动失败。本研究旨在探讨性别在 CDA 后的长期结果中的作用。
对接受单节段 CDA 和 BRYAN 颈椎间盘假体的患者进行回顾性、单中心研究，包括对颈椎结构和生物力学特征中性别差异的叙述性综述。
研究患者（14 名男性，30 名女性）的平均随访时间为 9.8 ± 3.2 年。在 Neck Disability Index 术前评估的特定项目中，男女之间存在显著差异，女性报告疼痛评分更差（P=0.05）。按年龄分层后，我们发现<36 岁的女性患者的总体 Neck Disability Index 术前评分更高（P=0.03）。在性别、体重指数特异性比较中，我们还发现 Neck Disability Index 术前评分存在显著差异，正常体重的男性患者比超重的男性患者差（P=0.05）。在影像学水平上，我们发现男性患者异位骨化发生率较高的趋势（男性为 62%，女性为 17%，P=0.06）。女性颈椎具有独特的特征，包括骨结构、肌肉作用、软组织反应以及对骨关节炎的遗传和表观遗传反应。
在我们的单节段 CDA 系列中，女性患者的活动失败发生率较低。静态和动态特征中的几个性别特异性因素可能在脊柱病理学和 CDA 长期影像学结果中发挥重要作用。
