Evan Teo Yu Ze, Yen Joshua Wong Rui, Seow Dexter, Jiali Corin Chen, Kumar Laranya, Baskar Sangeetha, Liang Shen, Kumar Naresh
Department of Orthopaedic Surgery, National University Health System, Singapore.
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Asian Spine J. 2023 Aug;17(4):729-738. doi: 10.31616/asj.2022.0302. Epub 2023 Jul 6.
Retrospective single-center, single-surgeon cohort study.
Our goal was to compare the 2-year clinical and radiological results of artificial disc replacement (ADR) and cage screw (CS) implants in patients with cervical degenerative disc disease (DDD).
Anterior cervical discectomy and fusion with CS implants are an acceptable alternative to traditional cageplate construct due to perceived decreased complications of dysphagia. However, patients may experience adjacent segment disease because of increased motion and intradiscal pressure. ADR is an alternative to restore the physiological kinematics of the operated disc. Few studies directly compare ADR and CS construct for their efficacy.
Patients who received single-level ADR or CS between January 2008 and December 2018 were included. Data collected was preoperatively, intraoperatively, and postoperatively (6, 12, 24 months). Demographic information, surgical information, complications, follow-up surgery, and outcome ratings (Japanese Orthopaedic Association [JOA], Neck Disability Index [NDI], Visual Analog Scale [VAS] neck and arm, 36-item Short Form Health Survey [SF-36], EuroQoL-5 Dimension [EQ-5D]) were gathered. The radiological assessment included motion segment height, adjacent disc height, lordosis, cervical lordosis, T1 slope, the sagittal vertical axis C2-7, and adjacent level ossification development (ALOD).
Fifty-eight patients were included (ADR: 37 and CS: 21). At 6 months, both groups' JOA, VAS, NDI, SF-36, and EQ-5D scores significantly improved, and the positive trends persisted at 2 years. Noted no significant difference in the enhancement of clinical scores except for the VAS arm (ADR: 5.95 vs. CS: 3.43, p =0.001). Radiological parameters were comparable except for the progression of ALOD of the subjacent disc (ADR: 29.7% vs. CS: 66.9%, p =0.02). No significant difference in adverse events or severe complications seen.
ADR and CS obtain good clinical results for symptomatic single-level cervical DDD. ADR demonstrated a significant advantage over CS in the improvement of VAS arm and reduced progression of ALOD of the adjacent lower disc. No statistically significant difference of dysphonia or dysphagia between the two groups were seen, attributed to their comparable zero profile.
回顾性单中心、单术者队列研究。
我们的目标是比较人工椎间盘置换术（ADR）和椎间融合器螺钉（CS）植入术治疗颈椎间盘退变疾病（DDD）患者的2年临床和影像学结果。
由于吞咽困难并发症减少，前路颈椎间盘切除及CS植入融合术是传统椎间融合器钢板结构的可接受替代方案。然而，由于活动度增加和椎间盘内压力升高，患者可能会出现相邻节段疾病。ADR是恢复手术节段生理运动学的一种替代方法。很少有研究直接比较ADR和CS结构的疗效。
纳入2008年1月至2018年12月期间接受单节段ADR或CS手术的患者。收集术前、术中及术后（6、12、24个月）的数据。收集人口统计学信息、手术信息、并发症、二次手术及疗效评分（日本骨科协会[JOA]评分、颈部功能障碍指数[NDI]、视觉模拟量表[VAS]颈部和手臂评分、36项简明健康调查问卷[SF-36]、欧洲五维健康量表[EQ-5D]）。影像学评估包括运动节段高度、相邻椎间盘高度、前凸、颈椎前凸、T1斜率、矢状垂直轴C2-7以及相邻节段骨化进展（ALOD）。
共纳入58例患者（ADR组37例，CS组21例）。6个月时，两组的JOA、VAS、NDI、SF-36和EQ-5D评分均显著改善，且在2年时呈持续改善趋势。除VAS手臂评分外，两组临床评分改善无显著差异（ADR组：5.95 vs. CS组：3.43，p =0.001）。除相邻椎间盘ALOD进展外，影像学参数相当（ADR组：29.7% vs. CS组：66.9%，p =0.02）。不良事件或严重并发症无显著差异。
ADR和CS治疗单节段有症状的颈椎DDD均取得了良好的临床效果。ADR在改善VAS手臂评分和减少相邻下椎间盘ALOD进展方面显示出优于CS的显著优势。两组间在发音困难或吞咽困难方面无统计学显著差异，这归因于它们相似的零切迹设计。
