Deng Yuxiao, He Junbo, Chen Hua, Wang Beiyu, Gong Quan, Li Tao, Liu Hao
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2024 Aug;16(8):1893-1902. doi: 10.1111/os.14120. Epub 2024 Jun 11.
Cervical alignment and range of motion (ROM) changes after cervical spine surgery are related to cervical biomechanical and functions. Few studies compared these parameters between posterior laminoplasty and anterior 3-level hybrid surgery incorporating anterior cervical discectomy and fusion (ACDF) with cervical disc replacement (CDR). This study is aimed to detect the differences of cervical alignment and ROM changes of the two surgeries in a matched-cohort study.
From January 2018 and May 2020, 51 patients who underwent 3-level hybrid surgery incorporating ACDF with ACDR were included. A 1:1 match of the patients who underwent cervical laminoplasty based on age, gender, duration of symptoms, body mass index, and cervical alignment type was utilized as control group. General data (operative time, blood loss, etc.), Japanese Orthopaedic Association (JOA) score, VAS (Visual Analog Score), NDI (The Neck Disability Index), cervical sagittal alignment, and cervical range of motion (ROM) were recorded and compared.
Both groups gained significant improvement in JOA, VAS, NDI scores postoperatively (p < 0.05). Cervical alignment significantly increased in hybrid group and decreased in control group after surgeries (p < 0.001). ROM decrease was similar in two groups. For cervical lordosis, though cervical alignment angle in control group decreased, the final follow-up cervical alignment and cervical alignment changes were not significantly different between hybrid and control groups. For cervical non-lordosis, cervical alignment decreased in control group while increased in hybrid group. At final follow-up, cervical alignment and the changes between the two groups were significantly different. Both control group and hybrid group had similar ROM decrease after the surgery no matter whether there was cervical lordosis or non-lordosis. Hybrid surgery showed cervical alignments significantly improved and similar ROM preservation compared with control group at final follow-up both for 1-level and 2-level disc replacement subgroups.
The hybrid surgery demonstrated advantages of preserving cervical alignment and gaining similar cervical ROM preservation compared with cervical laminoplasty, especially for cervical non-lordosis. Given the importance of restoring lordotic cervical alignment, hybrid surgery may be preferred over laminoplasty to treat multilevel cervical disc herniation.
颈椎手术后颈椎排列和活动范围（ROM）的变化与颈椎生物力学及功能相关。很少有研究比较后路椎板成形术与前路三级混合手术（包括颈椎前路椎间盘切除融合术（ACDF）和颈椎间盘置换术（CDR））之间的这些参数。本研究旨在通过一项匹配队列研究检测这两种手术在颈椎排列和ROM变化方面的差异。
纳入2018年1月至2020年5月期间接受ACDF联合ACDR的三级混合手术的51例患者。根据年龄、性别、症状持续时间、体重指数和颈椎排列类型，将接受颈椎椎板成形术的患者按1:1匹配作为对照组。记录并比较一般资料（手术时间、失血量等）、日本骨科协会（JOA）评分、视觉模拟评分（VAS）、颈部功能障碍指数（NDI）、颈椎矢状面排列和颈椎活动范围（ROM）。
两组术后JOA、VAS、NDI评分均有显著改善（p＜0.05）。混合组手术后颈椎排列显著增加，对照组手术后颈椎排列减少（p＜0.001）。两组ROM的降低相似。对于颈椎前凸，尽管对照组颈椎排列角度减小，但混合组与对照组在末次随访时的颈椎排列及颈椎排列变化无显著差异。对于颈椎非前凸，对照组颈椎排列减少，混合组颈椎排列增加。在末次随访时，两组的颈椎排列及变化有显著差异。无论有无颈椎前凸，对照组和混合组术后ROM降低相似。在末次随访时，对于单节段和双节段椎间盘置换亚组，混合手术均显示颈椎排列显著改善且ROM保留情况与对照组相似。
与颈椎椎板成形术相比，混合手术在保持颈椎排列和获得相似的颈椎ROM保留方面具有优势，尤其是对于颈椎非前凸。鉴于恢复颈椎前凸排列的重要性，在治疗多节段颈椎间盘突出症时，混合手术可能比椎板成形术更可取。
