Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Clin Spine Surg. 2024 Feb 1;37(1):E37-E42. doi: 10.1097/BSD.0000000000001543. Epub 2023 Oct 17.
Retrospective Cohort.
To evaluate patient-reported outcome measures (PROM) and minimal clinically important difference (MCID) achievement outcomes between anterior cervical discectomy and fusion (ACDF) and cervical disk replacement (CDR) in the Workers' Compensation (WC) population.
No studies to our knowledge have compared PROMs and MCID attainment between ACDF and CDR among patients with WC insurance undergoing surgery in an outpatient ambulatory surgical center (ASC).
WC insurance patients undergoing primary, single/double-level ACDF/CDR in an ASC were identified. Patients were divided into ACDF versus CDR. PROMs were collected at preoperative/6-week/12-week/6-month/1-year timepoints, including PROMIS-PF, SF-12 PCS/MCS, VAS neck/arm, and NDI.
Seventy-nine patients were included, 51 ACDF/28 CDR. While operative time (56.4 vs. 54.4 min), estimated blood loss (29.2 vs. 25.9 mL), POD0 pain (4.9 vs. 3.8), and POD0 narcotic consumption (21.2 vs. 14.5 oral morphine equivalents) were higher in ACDF patients, none reached statistical significance ( P >0.050, all). One-year arthrodesis rate was 100.0% among ACDF recipients with available imaging (n=36). ACDF cohort improved from preoperative for PROMIS-PF from 12 weeks to 1 year, SF-12 PCS at 6 months, all timepoints for VAS neck/arm, and 12 weeks/6 months for NDI ( P ≤0.044, all). CDR cohort improved from preoperative for PROMIS-PF at 6 months, VAS neck/arm from 12 weeks to 1 year, and NDI at 12 weeks/6 months ( P ≤0.049, all). CDR cohort reported significantly lower VAS neck at 12 weeks/1 year and VAS arm at 12 weeks ( P ≤0.039, all). MCID achievement rates did not differ.
While operative duration/estimated blood loss/acute postoperative pain/narcotic consumption were, on average, higher among ACDF recipients, these were not statistically significant, possibly due to the limited sample size. ACDF and CDR ASC patients generally demonstrated comparable arm pain/disability/physical function/mental health, though neck pain was significantly lower at multiple timepoints among CDR patients. Clinically meaningful PROM improvements were comparable. Larger, multicentered studies are required to confirm our results.
回顾性队列研究。
评估在工人赔偿（WC）人群中，前路颈椎间盘切除融合术（ACDF）与颈椎间盘置换术（CDR）的患者报告结局测量（PROM）和最小临床重要差异（MCID）的结果。
据我们所知，在门诊脊柱外科中心（ASC）接受手术的有 WC 保险的患者中，尚无比较 ACDF 和 CDR 之间 PROM 和 MCID 获得的研究。
确定在 ASC 中接受初次、单/双节段 ACDF/CDR 的 WC 保险患者。患者分为 ACDF 与 CDR 组。在术前/6 周/12 周/6 个月/1 年时间点收集 PROM，包括 PROMIS-PF、SF-12 PCS/MCS、VAS 颈/臂和 NDI。
共纳入 79 例患者，51 例行 ACDF/28 例行 CDR。虽然 ACDF 患者的手术时间（56.4 分钟比 54.4 分钟）、估计失血量（29.2 毫升比 25.9 毫升）、术后第 0 天疼痛（4.9 分比 3.8 分）和术后第 0 天阿片类药物消耗量（21.2 毫克比 14.5 毫克吗啡当量）较高，但均无统计学意义（P＞0.050，均）。有可用影像学资料的 ACDF 受者的 1 年融合率为 100.0%（n=36）。ACDF 组从术前到 12 周时的 PROMIS-PF、6 个月时的 SF-12 PCS、所有时间点的 VAS 颈/臂和 12 周/6 个月时的 NDI 均有改善（P≤0.044，均）。CDR 组从术前到 6 个月时的 PROMIS-PF、12 周时的 VAS 颈/臂和 12 周/6 个月时的 NDI 均有改善（P≤0.049，均）。CDR 组在 12 周/1 年时的 VAS 颈和 12 周时的 VAS 臂的报告值显著较低（P≤0.039，均）。MCID 达标率无差异。
尽管 ACDF 受者的手术时间/估计失血量/急性术后疼痛/阿片类药物消耗量平均较高，但无统计学意义，可能与样本量有限有关。ACDF 和 CDR ASC 患者的手臂疼痛/残疾/身体功能/心理健康一般相当，但 CDR 患者在多个时间点的颈部疼痛明显较低。有临床意义的 PROM 改善相当。需要更大规模的多中心研究来证实我们的结果。
