颈椎前路减压融合术治疗退行性椎间盘疾病后 20 多年的疼痛和残疾随访，并比较两种手术技术。
A more than 20-year follow-up of pain and disability after anterior cervical decompression and fusion surgery for degenerative disc disease and comparisons between two surgical techniques.
机构信息
Department of Health, Medicine and Caring Sciences, Unit of Physiotherapy, Linköping University, Building 511, Entrance 76, Level 15, Linköping, SE-581 83, Sweden.
Aleris Ortopedi, Nacka Specialistsjukhus, Stockholm, Sweden.
出版信息
BMC Musculoskelet Disord. 2023 May 22;24(1):406. doi: 10.1186/s12891-023-06503-w.
BACKGROUND
Follow-ups more than 20 years after neck surgery are extremely rare. No previous randomized studies have investigated differences in pain and disability more than 20 years after ACDF surgery using different techniques. The purpose of this study was to describe pain and functioning more than 20 years after anterior cervical decompression and fusion surgery, and to compare outcomes between the Cloward Procedure and the carbon fiber fusion cage (CIFC).
METHODS
This study is a 20 to 24-year follow-up of a randomized controlled trial. Questionnaires were sent to 64 individuals, at least 20 years after ACDF due to cervical radiculopathy. Fifty individuals (mean age 69, 60% women, 55% CIFC) completed questionnaires. Mean time since surgery was 22.4 years (range 20,5-24). Primary outcomes were neck pain and neck disability index (NDI). Secondary outcomes were frequency and intensity of neck and arm pain, headache, dizziness, self-efficacy, health related quality of life or global outcome. Clinically relevant improvements were defined as 30 mm decrease in pain and a decrease in disability of 20 percentage units. Between-group differences over time were analyzed with mixed design ANOVA and relationships between main outcomes and psychosocial factors were analyzed by Spearman´s rho.
RESULTS
Neck pain and NDI score significantly improved over time (p < .001), with no group differences in primary or secondary outcomes. Eighty-eight per cent of participants experienced improvements or full recovery, 71% (pain) and 41% (NDI) had clinically relevant improvements. Pain and NDI were correlated with lower self-efficacy and quality of life.
CONCLUSION
The results from this study do not support the idea that fusion technique affects long-term outcome of ACDF. Pain and disability improved substantially over time, irrespective of surgical technique. However, the majority of participants reported residual disability not to a negligible extent. Pain and disability were correlated to lower self-efficacy and quality of life.
背景
颈部手术后 20 年以上的随访极为罕见。以前没有随机研究使用不同技术调查 ACDF 手术后 20 年以上的疼痛和残疾差异。本研究的目的是描述颈椎前路减压融合术（ACDF）后 20 年以上的疼痛和功能，并比较 Cloward 手术与碳纤维融合笼（CIFC）的结果。
方法
这是一项对随机对照试验的 20 至 24 年随访研究。向至少因颈椎神经根病接受 ACDF 术后 20 年的 64 名患者发送了问卷。50 名患者（平均年龄 69 岁，60%为女性，55%为 CIFC）完成了问卷。手术时间平均为 22.4 年（范围 20.5-24）。主要结局是颈部疼痛和颈部残疾指数（NDI）。次要结局是颈部和手臂疼痛、头痛、头晕、自我效能、健康相关生活质量或总体结局的频率和强度。定义临床相关改善为疼痛减少 30 毫米和残疾程度降低 20 个百分点。采用混合设计方差分析分析随时间的组间差异，并通过 Spearman's rho 分析主要结局与心理社会因素的关系。
结果
颈部疼痛和 NDI 评分随时间显著改善（p < 0.001），主要和次要结局在组间无差异。88%的参与者经历了改善或完全康复，71%（疼痛）和 41%（NDI）有临床相关改善。疼痛和 NDI 与较低的自我效能和生活质量相关。
结论
本研究结果不支持融合技术影响 ACDF 长期结果的观点。疼痛和残疾随时间显著改善，与手术技术无关。然而，大多数参与者报告存在不可忽略的残留残疾。疼痛和残疾与较低的自我效能和生活质量相关。
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