Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Capio Spine Center Stockholm, Löwenströmska Hospital, 194 02 Upplands-Väsby, Box 2074, Stockholm, Sweden.
Acta Neurochir (Wien). 2024 Jul 3;166(1):280. doi: 10.1007/s00701-024-06172-1.
INTRODUCTION: Anterior Cervical Discectomy and Fusion (ACDF) and Anterior Cervical Corpectomy and Fusion (ACCF) are both common surgical procedures in the management of pathologies of the subaxial cervical spine. While recent reviews have demonstrated ACCF to provide better decompression results compared to ACDF, the procedure has been associated with increased surgical risks. Nonetheless, the use of ACCF in a traumatic context has been poorly described. The aim of this study was to assess the safety of ACCF as compared to the more commonly performed ACDF. METHODS: All patients undergoing ACCF or ACDF for subaxial cervical spine injuries spanning over 2 disc-spaces and 3 vertebral-levels, between 2006 and 2018, at the study center, were eligible for inclusion. Patients were matched based on age and preoperative ASIA score. RESULTS: After matching, 60 patients were included in the matched analysis, where 30 underwent ACDF and ACCF, respectively. Vertebral body injury was significantly more common in the ACCF group (p = 0.002), while traumatic disc rupture was more frequent in the ACDF group (p = 0.032). There were no statistically significant differences in the rates of surgical complications, including implant failure, wound infection, dysphagia, CSF leakage between the groups (p ≥ 0.05). The rates of revision surgeries (p > 0.999), mortality (p = 0.222), and long-term ASIA scores (p = 0.081) were also similar. CONCLUSION: Results of both unmatched and matched analyses indicate that ACCF has comparable outcomes and no additional risks compared to ACDF. It is thus a safe approach and should be considered for patients with extensive anterior column injury.
简介:前路颈椎间盘切除融合术(ACDF)和前路颈椎椎体次全切除融合术(ACCF)都是治疗下颈椎病变的常用手术方法。虽然最近的综述表明 ACCF 比 ACDF 提供更好的减压效果,但该手术与更高的手术风险相关。然而,ACCF 在创伤情况下的应用描述较少。本研究旨在评估 ACCF 与更常见的 ACDF 相比的安全性。
方法:研究中心对 2006 年至 2018 年间接受下颈椎多节段(2 个椎间盘-节段)、3 个椎体水平的前路颈椎损伤手术的患者进行了回顾性分析,符合条件的患者接受了 ACCF 或 ACDF 治疗。根据年龄和术前 ASIA 评分进行匹配。
结果:匹配后,60 例患者纳入匹配分析,其中 30 例患者分别接受了 ACDF 和 ACCF 治疗。ACCF 组的椎体骨折明显更常见(p=0.002),而 ACDF 组的创伤性椎间盘破裂更常见(p=0.032)。两组之间手术并发症(包括植入物失败、伤口感染、吞咽困难、CSF 漏)的发生率无统计学差异(p≥0.05)。两组之间的翻修手术率(p>0.999)、死亡率(p=0.222)和长期 ASIA 评分(p=0.081)也相似。
结论:无论是非匹配还是匹配分析的结果均表明,ACCF 与 ACDF 相比具有相似的结果,且无额外风险。因此,对于广泛的前柱损伤患者,这是一种安全的方法,应予以考虑。
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