Martin Davis, Schroeder Ryan, Toups Collin, Daigle Clifton, Spitchley Matthew, Leonardi Claudia, Shammassian Berje, Bhandutia Amit K
Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA.
Int J Spine Surg. 2024 Nov 4;18(6):645-52. doi: 10.14444/8657.
Previous research suggests a relationship between complications associated with anterior cervical discectomy and fusion and level involvement; however, there is limited research comparing postoperative outcomes of upper cervical fusions (UCFs) with middle-to-lower cervical fusions (MLCFs). This study aims to compare the outcomes of UCF with MLCF.
A retrospective medical record review was conducted on 835 anterior cervical discectomy and fusion patients from 2012 to 2022. Patients were classified as UCF, defined as inclusion of C3 to C4 disc space, or MLCF, defined as lacking C3 to C4 disc space. Demographics were compared using or Fisher exact tests. Clinical characteristics were compared in univariable analysis using tests, linear-mixed effects models, or generalized linear-mixed models depending on distribution. Significant pre- and intraoperative characteristics were included in multivariable models to minimize confounding.
Of the 835 patients included, 562 underwent MLCF and 281 underwent UCF. Median follow-up time was 211 days for UCF and 200 days for MLCF. UCF led to a 1.5-day longer length of stay in both univariable (1.5 vs 3.1, < 0.0001) and multivariable analysis (2.3 days [95% CI: 1.8, 3.0] vs 3.3 days [2.6, 4.2], < 0.0001). MLCF patients reported symptom improvement or resolution more often than UCF patients (0.43 [95% CI: 0.30, 0.62] and 0.46 [95% CI: 0.30, 0.70]). Additionally, a significantly higher rate of dysphagia was reported in the UCF group on both univariate and multivariable analysis, respectively (1.72 [95% CI: 1.18, 2.49] and 1.66 [95%CI: 1.08, 2.56]).
To our knowledge, this is the first study to investigate the link between cervical fusion level and outcomes. UCF patients demonstrated greater rates of dysphagia, longer length of stay, and lower likelihood of improvement in neurological symptoms postoperatively both before and after controlling for differences in pre- and intraoperative characteristics.
This study highlights that UCFs may be associated with worse postoperative outcomes when compared to MLCFs, which can inform surgical decision-making and patient counseling.
The study represents Level 3 evidence due to its retrospective design and potential biases, indicating a need for future prospective randomized controlled trials to validate these findings.
先前的研究表明，颈椎前路椎间盘切除融合术相关并发症与受累节段之间存在关联；然而，比较上颈椎融合术（UCF）与中下段颈椎融合术（MLCF）术后结果的研究有限。本研究旨在比较UCF与MLCF的结果。
对2012年至2022年的835例颈椎前路椎间盘切除融合术患者进行回顾性病历审查。患者分为UCF（定义为包括C3至C4椎间盘间隙）或MLCF（定义为不包括C3至C4椎间盘间隙）。使用t检验或Fisher精确检验比较人口统计学数据。根据分布情况，在单变量分析中使用t检验、线性混合效应模型或广义线性混合模型比较临床特征。将显著的术前和术中特征纳入多变量模型以尽量减少混杂因素。
在纳入的835例患者中，562例行MLCF，281例行UCF。UCF的中位随访时间为211天，MLCF为200天。在单变量分析（1.5天对3.1天，P<0.0001）和多变量分析（2.3天[95%CI：1.8，3.0]对3.3天[2.6，4.2]，P<0.0001）中，UCF均导致住院时间延长1.5天。MLCF患者比UCF患者更常报告症状改善或缓解（分别为0.43[95%CI：0.30，0.62]和0.46[95%CI：0.30，0.70]）。此外，在单变量和多变量分析中，UCF组吞咽困难的发生率均显著更高（分别为1.72[95%CI：1.18，2.49]和1.66[95%CI：1.08，2.56]）。
据我们所知，这是第一项研究颈椎融合节段与结果之间联系的研究。在控制术前和术中特征差异前后，UCF患者术后吞咽困难发生率更高、住院时间更长且神经症状改善的可能性更低。
本研究强调，与MLCF相比，UCF术后结果可能更差，这可为手术决策和患者咨询提供参考。
由于本研究的回顾性设计和潜在偏倚，该研究为3级证据，表明未来需要进行前瞻性随机对照试验来验证这些发现。
