Song Kwang-Sup, Lee Jeongik, Ham Dae Woong, Jung Chan-Woo, Kang Hyun, Park Seung Won, Chang Dong-Gune, Kim Youngbae B
Department of Orthopaedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Asian Spine J. 2023 Jun;17(3):492-499. doi: 10.31616/asj.2022.0192. Epub 2023 Feb 13.
Retrospective observational study.
This study aimed to investigate the impact of plating on postoperative serial segmental motion and its correlation with clinical outcomes in single-level anterior cervical discectomy and fusion (ACDF) for up to 1 year.
The advantages and disadvantages of using cervical plating in ACDF have been well discussed; however, few studies compared the early serial segmental motions at the postoperative level between plating and non-plating.
In retrospectively collected data, 149 patients who underwent single-level ACDF for degenerative disease were enrolled and divided into non-plating (n=66) and plating (n=83). Interspinous motion (ISM) at the arthrodesis segment, Numeric Rating Scale (NRS) for neck pain, and Neck Disability Index (NDI) were serially evaluated at 3, 6, and 12 months postoperatively. Predictable factors for fusion, including age, sex, plating, diabetes, smoking, and type of grafts, were investigated, and fusion was defined as ISM <1 mm.
In both groups, ISM was the highest at 3 months and gradually decreased thereafter, and the plating group showed significantly lower serial ISM than the non-plating group at 12 months. The plating group had lower NRS and NDI scores than the nonplating group at 12 months, and the difference in the NRS scores was statistically significant, particularly at 3 and 6 months, although that of the NDI scores was not. In a multivariate analysis, plating was the most powerful predictor for fusion.
Plating significantly decreases the serial ISM compared with non-plating in single-level ACDF, and such decreased motion is correlated with decreased neck pain until 12 months postoperatively, particularly at 3 and 6 months. Given that plating was the most predictive factor for fusion, we recommend plating even in single-level ACDF for better early clinical outcomes.
回顾性观察研究。
本研究旨在探讨钢板固定对单节段前路颈椎间盘切除融合术（ACDF）术后连续节段运动的影响及其与长达1年临床疗效的相关性。
ACDF中使用颈椎钢板的优缺点已得到充分讨论；然而，很少有研究比较钢板固定和非钢板固定术后早期节段运动情况。
回顾性收集数据，纳入149例因退行性疾病接受单节段ACDF的患者，分为非钢板固定组（n = 66）和钢板固定组（n = 83）。在术后3、6和12个月连续评估融合节段的棘突间运动（ISM）、颈部疼痛数字评分量表（NRS）和颈部功能障碍指数（NDI）。研究融合的预测因素，包括年龄、性别、钢板固定、糖尿病、吸烟和移植物类型，融合定义为ISM <1 mm。
两组中，ISM在3个月时最高，此后逐渐下降，钢板固定组在12个月时的连续ISM明显低于非钢板固定组。钢板固定组在12个月时的NRS和NDI评分低于非钢板固定组，NRS评分差异有统计学意义，特别是在3和6个月时，尽管NDI评分差异无统计学意义。多因素分析显示，钢板固定是融合的最强预测因素。
在单节段ACDF中，与非钢板固定相比，钢板固定显著降低连续ISM，这种运动减少与术后12个月内颈部疼痛减轻相关，尤其是在3和6个月时。鉴于钢板固定是融合的最具预测性因素，我们建议即使在单节段ACDF中也采用钢板固定以获得更好的早期临床疗效。
