Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
World Neurosurg. 2022 Sep;165:e597-e610. doi: 10.1016/j.wneu.2022.06.109. Epub 2022 Jun 26.
This study assesses cervical alignments after 2-level cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) with anterior plate fixation.
Eighty-two patients who underwent 2-level CDA or ACDF in 2014-2019 were identified. Cervical alignment parameters were compared between the 2 cohorts. Subgroup analyses were performed to determine factors that differentiate alignment outcomes between the 2 procedures.
Although both cohorts achieved significant focal lordosis (FL) and overall cervical lordotic (CL) gains, CDA cohorts achieved significantly greater 12-month FL gain (P = 0.022). However, in a multivariate analysis controlling for preoperative variables, FL gain was no longer significant. Although the CDA cervical sagittal vertical axis (cSVA) significantly improved at 3 (P = 0.030) and 12 (P = 0.007) months, these improvements were not superior to the ACDF cSVA. Male patients undergoing CDA achieved greater 12-month CL gain. Patients undergoing CDA with body mass index >25 kg/m achieved greater 12-month FL gain. Patients undergoing CDA with symptom duration >12 months achieved greater FL gain at 3 and 12 months. Patients undergoing CDA with high baseline T1 slope or cSVA achieved greater 12-month cSVA reduction. Clinical outcomes were comparable between the 2 cohorts. Unlike the ACDF group, CL gain in the CDA group was significantly correlated with the cSVA reduction, which was associated with significant improvement in the Neck Disability Index, arm pain, and 12-Item Short-Form Mental Component Scores. Heterotopic ossification was not found to significantly affect patient outcome and cervical alignment in both cohorts.
ACDF and CDA are viable options for 2-level degenerative disc disease in carefully selected patients. Both approaches produced equivalent postoperative alignment changes in a 2-level operation.
本研究评估了 2 级颈椎间盘置换术（CDA）与前路颈椎间盘切除融合术（ACDF）联合前路钢板固定后颈椎排列的情况。
在 2014 年至 2019 年间，共确定了 82 例接受 2 级 CDA 或 ACDF 的患者。比较了两组患者的颈椎排列参数。进行了亚组分析，以确定两种手术之间的排列结果差异的因素。
尽管两组患者的焦点前凸（FL）和整体颈椎前凸（CL）均显著增加，但 CDA 组在 12 个月时的 FL 增加显著更大（P=0.022）。然而，在控制术前变量的多变量分析中，FL 增加不再显著。尽管 CDA 的颈椎矢状垂直轴（cSVA）在 3 个月（P=0.030）和 12 个月（P=0.007）时显著改善，但这些改善并不优于 ACDF 的 cSVA。接受 CDA 的男性患者在 12 个月时获得更大的 CL 增加。接受 CDA 且 BMI 大于 25kg/m2的患者在 12 个月时获得更大的 FL 增加。接受 CDA 且症状持续时间大于 12 个月的患者在 3 个月和 12 个月时获得更大的 FL 增加。接受 CDA 且基线 T1 斜率或 cSVA 较高的患者在 12 个月时获得更大的 cSVA 减少。两组患者的临床结果相当。与 ACDF 组不同，CDA 组的 CL 增加与 cSVA 减少显著相关，这与 Neck Disability Index、手臂疼痛和 12 项简明精神成分评分的显著改善相关。在两组患者中，异位骨化均未显著影响患者的预后和颈椎排列。
在精心选择的患者中，ACDF 和 CDA 是 2 级退行性椎间盘疾病的可行选择。两种方法在 2 级手术中都产生了等效的术后排列变化。
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