From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
J Am Acad Orthop Surg. 2024 Jun 15;32(12):558-562. doi: 10.5435/JAAOS-D-23-00655. Epub 2024 Apr 30.
INTRODUCTION: Patients with a prolonged preoperative symptom duration (PSD) in the setting of cervical disk herniation (DH) may suffer inferior outcomes after surgical intervention. Comparison between anterior cervical diskectomy and fusion (ACDF) versus cervical disk arthroplasty (CDA) in this at-risk population has not yet been conducted. METHODS: Patients undergoing ACDF or CDA for DH with a PSD > 180 days were selected. Six-week (6W) and final follow-up (FF) patient-reported outcome measures (PROMs) as well as magnitude of postoperative improvements (∆PROM) were compared between cohorts using multivariable linear regression. Intercohort achievement rates of minimal clinically important difference (MCID) in each PROM were compared. RESULTS: Seventy-seven of 190 patients were in the CDA cohort. 6W Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF) was superior in the CDA cohort. The ACDF cohort demonstrated notable improvements in the 6W Neck Disability Index (NDI), visual analog scale-neck pain (VAS-N), visual analog scale-arm pain (VAS-A), and 9-item Patient Health Questionnaire (PHQ-9). The CDA cohort demonstrated notable improvements in 6W PROMIS-PF, NDI, VAS-N, and VAS-A. FF VAS-A was better in the CDA cohort. The ACDF cohort demonstrated notable improvements in FF PROMIS-PF, NDI, VAS-N, and VAS-A. The CDA cohort demonstrated notable improvements in all FF PROMs. ∆PROM-6W in PROMIS-PF was greater in the CDA cohort. CONCLUSION: Patients with prolonged PSD due to cervical DH demonstrated notable improvements in physical function, disability, pain, and mental health regardless of fusion versus arthroplasty techniques. Accounting for demographic variations, patients undergoing CDA demonstrated a greater magnitude of improvement and superior scores in physical function at the first postoperative follow-up. Rates of clinically tangible improvements in PROMs did not markedly vary by surgical procedure. Patients undergoing CDA may perceive greater early improvements to physical function compared with patients undergoing ACDF for prolonged PSD due to DH.
介绍：颈椎间盘突出症（DH）患者术前症状持续时间（PSD）较长，手术干预后可能预后较差。在高危人群中，比较前路颈椎间盘切除术和融合术（ACDF）与颈椎间盘置换术（CDA）的疗效尚未进行。
方法：选择 PSD ＞ 180 天的 DH 患者行 ACDF 或 CDA 治疗。使用多变量线性回归比较两组患者术后 6 周（6W）和最终随访（FF）时的患者报告结局测量（PROM）以及术后改善程度（∆PROM）。比较两组患者在各 PROM 中达到最小临床重要差异（MCID）的比例。
结果：190 例患者中 77 例入组 CDA 组。6W PROMIS 物理功能（PROMIS-PF）评分在 CDA 组中更高。ACDF 组在 6W 颈痛残疾指数（NDI）、视觉模拟量表-颈部疼痛（VAS-N）、视觉模拟量表-上肢疼痛（VAS-A）和 9 项患者健康问卷（PHQ-9）中显著改善。CDA 组在 6W PROMIS-PF、NDI、VAS-N 和 VAS-A 中也有显著改善。FF VAS-A 在 CDA 组中更好。ACDF 组在 FF PROMIS-PF、NDI、VAS-N 和 VAS-A 中显著改善。CDA 组在所有 FF PROM 中均有显著改善。6W 时的 PROMIS-PF ∆PROM 在 CDA 组中更大。
结论：颈椎 DH 导致 PSD 延长的患者，无论融合术还是置换术，在生理功能、残疾、疼痛和心理健康方面均有显著改善。考虑到人口统计学差异，与 ACDF 相比，CDA 组术后即刻的生理功能改善幅度更大，评分更高。手术方式对 PROM 有临床意义的改善率无明显差异。与 ACDF 相比，CDA 可能会使颈椎 DH 导致 PSD 延长的患者在术后早期感受到更大的生理功能改善。
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