Department of Orthopedic Surgery, Loma Linda University Medical Center, Loma Linda, CA.
Loma Linda University School of Medicine, Loma Linda, CA.
Spine (Phila Pa 1976). 2023 Feb 15;48(4):261-269. doi: 10.1097/BRS.0000000000004506. Epub 2022 Oct 13.
STUDY DESIGN: A retrospective database study. OBJECTIVE: The purpose of our study was to compare the perioperative complications and reoperation rates after anterior cervical discectomy and fusion (ACDF), cervical disk arthroplasty (CDA), and posterior cervical foraminotomy (PCF) in patients treated for cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical radiculopathy results from compression or irritation of nerve roots in the cervical spine. While most cervical radiculopathy is treated nonoperatively, ACDF, CDA, and PCF are the techniques most commonly used if operative intervention is indicated. There is limited research evaluating the perioperative complications of these surgical techniques. MATERIALS AND METHODS: A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of cervical radiculopathy that underwent ACDF, CDA, or PCF at one or two levels from 2007 to 2016. Perioperative complications and reoperations following each of the procedures were assessed. RESULTS: During the study period, 25,051 patients underwent ACDF, 522 underwent CDA, and 3986 underwent PCF. After propensity score matching, each of the three groups consisted of 507 patients. Surgical site infection rates were highest after PCF (2.17%) compared with ACDF (0.20%) and CDA (0.59%) at 30 days and three months ( P =0.003, P <0.001), respectively. New-onset cervicalgia was highest following ACDF (34.32%) and lowest after PCF (22.88%) at three and six months ( P <0.001 and P =0.003), respectively. Revision surgeries were highest among those who underwent CDA (6.90%) versus ACDF (3.16%) and PCF (3.55%) at six months ( P =0.007). Limb paralysis was significantly higher after PCF compared with CDA and ACDF at six months ( P <0.017). CONCLUSIONS: The rate of surgical site infection was higher in PCF compared with ACDF and CDA. New-onset cervicalgia was higher after ACDF compared with PCF and CDA at short-term follow-up. Revision surgeries were highest among those undergoing CDA and lowest in those undergoing ACDF. LEVEL OF EVIDENCE: 3.
研究设计：回顾性数据库研究。
目的：我们的研究目的是比较颈椎神经根病患者接受前路颈椎间盘切除融合术（ACDF）、颈椎间盘置换术（CDA）和后路颈椎侧方减压术（PCF）治疗后的围手术期并发症和再次手术率。
背景资料总结：颈椎神经根病是由于颈椎神经根受压或受刺激引起的。虽然大多数颈椎神经根病采用非手术治疗，但如果需要手术干预，ACDF、CDA 和 PCF 是最常用的技术。目前关于这些手术技术围手术期并发症的研究有限。
材料和方法：使用 PearlDiver 患者记录数据库进行回顾性审查，以确定 2007 年至 2016 年期间在一个或两个节段接受 ACDF、CDA 或 PCF 治疗的颈椎神经根病病例。评估了每种手术的围手术期并发症和再次手术情况。
结果：在研究期间，25051 例患者接受了 ACDF，522 例接受了 CDA，3986 例接受了 PCF。经过倾向评分匹配后，每组 507 例患者。30 天和 3 个月时，手术部位感染率在 PCF 后最高（分别为 2.17%和 0.59%），与 ACDF（0.20%）和 CDA（0.59%）相比，差异有统计学意义（P=0.003，P<0.001）。新发性颈痛在 ACDF 后最高（34.32%），在 PCF 后最低（22.88%），差异有统计学意义（分别在 3 个月和 6 个月时，P<0.001 和 P=0.003）。6 个月时，CDA 组（6.90%）再次手术率高于 ACDF 组（3.16%）和 PCF 组（3.55%），差异有统计学意义（P=0.007）。与 CDA 和 ACDF 相比，PCF 组的肢体瘫痪在 6 个月时显著更高（P<0.017）。
结论：与 ACDF 和 CDA 相比，PCF 的手术部位感染率更高。与 CDA 和 ACDF 相比，ACDF 后新发颈痛在短期随访时更高。CDA 组的再次手术率最高，而 ACDF 组的再次手术率最低。
证据等级：3 级。
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