与颈椎前路椎间盘切除融合术或颈椎间盘置换术相比，多级后路颈椎椎间孔切开术术后感染率和再次手术率升高。
Multi-Level Posterior Cervical Foraminotomy Associated With Increased Post-operative Infection Rates and Overall Re-Operation Relative to Anterior Cervical Discectomy With Fusion or Cervical Disc Arthroplasty.
作者信息
Ng Mitchell K, Kobryn Andriy, Baidya Joydeep, Nian Patrick, Emara Ahmed K, Ahn Nicholas U, Houten John K, Saleh Ahmed, Razi Afshin E
机构信息
Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Department of Orthopaedic Surgery, SUNY Downstate College of Medicine, Brooklyn, NY, USA.
出版信息
Global Spine J. 2024 Apr;14(3):869-877. doi: 10.1177/21925682221124530. Epub 2022 Sep 2.
STUDY DESIGN
Retrospective Cohort Study.
OBJECTIVE
Cervical radiculopathy meeting operative criteria has traditionally been managed using anterior cervical discectomy and fusion (ACDF). However, cervical disc arthroplasty (CDA) and posterior cervical foraminotomy (PCF) are also reasonable options. This study aimed to assess differences in postoperative outcomes among patients undergoing multi-level ACDF, CDA, or PCF comparing medical/surgical complications and healthcare utilization parameters.
METHODS
Patients who underwent multi-level ACDF, CDA, or PCF between 2012 and 2019 were identified from the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database. Patients were stratified based on procedure type and propensity score matched to resolve baseline differences. ANOVA was performed to identify differences in medical complications, surgical complications, and healthcare utilization metrics.
RESULTS
A total of 31 344 patients who underwent an eligible procedure were identified (ACDF: n = 28 089, CDA: n = 1748, PCF: n = 1507), and 684 patients remained in each group following propensity score matching. Patients undergoing multi-level PCF were found to experience longer lengths of hospital stay (PCF: 1.67 ± 1.61 days, ACDF: 1.50 ± 1.32 days, CDA: 1.27 ± 1.05 days, < .001), higher rates of reoperation (PCF: 3.2%, ACDF: 1.0%, CDA: .4%, = .020), superficial infection (PCF: 1.3%, ACDF: .3%, CDA: .1%, = .008) and deep infection (PCF: 1.2%, ACDF: 0%, CDA: 0%, < .001). There were no outcome differences between multi-level ACDF and CDA.
CONCLUSIONS
Patients undergoing multi-level PCF were at increased risk for longer hospital stay, re-operation, and infection relative to those undergoing ACDF and CDA. Future research should aim to uncover the precise mechanisms underlying these complications, as well as analyze long term outcomes.
LEVEL OF EVIDENCE
III.
研究设计
回顾性队列研究。
目的
符合手术标准的神经根型颈椎病传统上采用颈椎前路椎间盘切除融合术（ACDF）治疗。然而，颈椎间盘置换术（CDA）和颈椎后路椎间孔切开术（PCF）也是合理的选择。本研究旨在评估接受多节段ACDF、CDA或PCF治疗的患者术后结果的差异，比较医疗/手术并发症和医疗资源利用参数。
方法
从美国外科医师学会国家外科质量改进项目（ACS-NSQIP）数据库中识别出2012年至2019年间接受多节段ACDF、CDA或PCF治疗的患者。根据手术类型对患者进行分层，并进行倾向评分匹配以消除基线差异。采用方差分析来确定医疗并发症、手术并发症和医疗资源利用指标的差异。
结果
共识别出31344例接受符合条件手术的患者（ACDF：n = 28089，CDA：n = 1748，PCF：n = 1507），倾向评分匹配后每组各有684例患者。发现接受多节段PCF治疗的患者住院时间更长（PCF：1.67±1.61天，ACDF：1.50±1.32天，CDA：1.27±1.05天，P <.001），再次手术率更高（PCF：3.2%，ACDF：1.0%，CDA：0.4%，P = 0.020），浅表感染率更高（PCF：1.3%，ACDF：0.
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