Lofrese Giorgio, Trungu Sokol, Scerrati Alba, De Bonis Pasquale, Cultrera Francesco, Mongardi Lorenzo, Montemurro Nicola, Piazza Amedeo, Miscusi Massimo, Tosatto Luigino, Raco Antonino, Ricciardi Luca
Neurosurgery Unit, Bufalini Hospital, 47521 Cesena, Italy.
NESMOS Department, "Sapienza" University of Rome, Sant'Andrea Hospital, 00185 Rome, Italy.
Life (Basel). 2023 Jul 14;13(7):1564. doi: 10.3390/life13071564.
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) represent effective alternatives in the management of multilevel cervical spondylotic myelopathy (CSM). A consensus on which of these techniques should be used is still missing.
The databases of three centers were reviewed (January 2011-December 2018) for patients with three-level CSM, who underwent three-level ACDF without plating or two-level ACCF with expandable cage (VBRC) or mesh (VBRM). Demographic data, surgical strategy, complications, and implant failure were analyzed. The Neck Disability Index (NDI), the Visual Analog Scale (VAS), and the cervical lordosis were compared between the two techniques at 3 and 12 months. Logistic regression analyses investigated independent factors influencing clinical and radiological outcomes.
Twenty-one and twenty-two patients were included in the ACDF and ACCF groups, respectively. The median follow-up was 18 months. ACDFs were associated with better clinical outcomes at 12 months (NDI: 8.3% vs. 19.3%, < 0.001; VAS: 1.3 vs. 2.6, = 0.004), but with an increased risk of loss of lordosis correction ≥ 1° (OR = 4.5; = 0.05). A higher complication rate in the ACDF group (33.3% vs. 9.1%; = 0.05) was recorded, but it negatively influenced only short-term clinical outcomes. ACCFs with VBRC were associated with a higher risk of major complications but ensured better 12-month lordosis correction ( = 0.002). No significant differences in intraoperative blood loss were noted.
Three-level ACDF without plating was associated with better clinical outcomes than two-level ACCF despite worse losses in lordosis correction, which is ideal for fragile patients without retrovertebral compressions. In multilevel CSM, the relationship between the degree of lordosis correction and clinical outcome advantages still needs to be investigated.
颈椎前路椎间盘切除融合术（ACDF）和颈椎前路椎体次全切除融合术（ACCF）是治疗多节段脊髓型颈椎病（CSM）的有效替代方法。目前对于应采用哪种技术仍未达成共识。
回顾了三个中心的数据库（2011年1月至2018年12月），纳入接受三节段ACDF（未使用钢板）或两节段ACCF（使用可扩张椎间融合器[VBRC]或椎间融合网[VBRM]）治疗的三节段CSM患者。分析人口统计学数据、手术策略、并发症和植入物失败情况。比较两种技术在3个月和12个月时的颈部残疾指数（NDI）、视觉模拟评分（VAS）和颈椎前凸。采用逻辑回归分析研究影响临床和放射学结果的独立因素。
ACDF组和ACCF组分别纳入21例和22例患者。中位随访时间为18个月。ACDF在12个月时临床效果更好（NDI：8.3%对19.3%，<0.001；VAS：1.3对2.6，=0.004），但颈椎前凸矫正丢失≥1°的风险增加（OR = 4.5；=0.05）。记录到ACDF组并发症发生率较高（33.3%对9.1%；=0.05），但仅对短期临床结果有负面影响。使用VBRC的ACCF主要并发症风险较高，但能确保更好的12个月颈椎前凸矫正（=0.002）。术中出血量无显著差异。
未使用钢板的三节段ACDF尽管颈椎前凸矫正丢失情况较差，但临床效果优于两节段ACCF，这对于无椎体后缘压迫的脆弱患者是理想选择。在多节段CSM中，颈椎前凸矫正程度与临床结果优势之间的关系仍需研究。
