Abdelmalek George, Uppal Harjot, Coban Daniel, Patel Neil, Changoor Stuart, Sahai Nikhil, Sinha Kumar, Hwang Ki, Emami Arash
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA.
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA.
Spine J. 2025 May;25(5):921-928. doi: 10.1016/j.spinee.2024.11.003. Epub 2024 Nov 27.
Cervical spondylotic myelopathy (CSM) is a progressive condition characterized by spinal cord compression secondary to disc degeneration. While anterior cervical discectomy and fusion (ACDF) has long been considered the standard surgical treatment for CSM, loss of motion segments after this procedure may lead to sequelae, including adjacent segment disease (ASD), further propagating loss of function and the potential requirement for revision procedures. More recently, cervical disc arthroplasty (CDA) has been introduced as a motion-preserving alternative to ACDF in CSM.
This study compares ACDF to CDA in patients with preoperative CSM.
STUDY DESIGN/SETTING: A matched cohort retrospective study.
About 110 patients were included in the final analysis; 55 underwent ACDF, and 55 underwent CDA.
Complication rates, myelopathic severity measured by the Nurick scale, and patient-reported outcomes measured by VAS-neck, VAS-arm, and NDI scores.
We examined patients who underwent either one or two-level ACDF or CDA with a minimum follow-up of 2 years. Patients were matched for age, sex, comorbid conditions, preoperative myelopathy severity, and the number of indicated operative levels. Demographics, perioperative data, and complication rates were compared between the two cohorts of patients. Patient-reported outcome measures were assessed at multiple follow-up intervals.
No significant differences were observed in demographics or perioperative data. Overall complication rates were similar between the two cohorts (p=.167). Rates of dysphagia (p=1.00), dysphonia (p=.157), infection (p=1.00), construct failure (p=.154), heterotopic ossification (p=.132), and ASD (p=.315) were similar between the two groups. Furthermore, revision rates were similar between the two groups (p=.315). No significant differences were observed in median postoperative Nurick scores between the two cohorts (p=1.00). NDI improvements were greater in the CDA cohort (p=.040).
ACDF and CDA had statistically similar complication rates and improvements in myelopathic symptoms. However, patients who underwent CDA had superior PROMs to those who had undergone ACDF.
脊髓型颈椎病（CSM）是一种进行性疾病，其特征是继发于椎间盘退变的脊髓受压。虽然颈椎前路椎间盘切除融合术（ACDF）长期以来一直被视为CSM的标准手术治疗方法，但该手术后运动节段的丧失可能会导致一系列后遗症，包括相邻节段疾病（ASD），进而导致功能进一步丧失以及可能需要进行翻修手术。最近，颈椎间盘置换术（CDA）已被引入，作为CSM中ACDF的一种保留运动功能的替代方法。
本研究比较了术前CSM患者的ACDF和CDA。
研究设计/设置：一项匹配队列回顾性研究。
最终分析纳入了约110例患者；55例行ACDF，55例行CDA。
并发症发生率、用Nurick量表测量的脊髓病严重程度以及用VAS颈部、VAS手臂和NDI评分测量的患者报告结局。
我们检查了接受单节段或双节段ACDF或CDA且随访至少2年的患者。根据年龄、性别、合并症、术前脊髓病严重程度和指定手术节段数量对患者进行匹配。比较了两组患者的人口统计学、围手术期数据和并发症发生率。在多个随访时间点评估患者报告的结局指标。
在人口统计学或围手术期数据方面未观察到显著差异。两组的总体并发症发生率相似（p = 0.167）。两组之间吞咽困难（p = 1.00）、发音障碍（p = 0.157）、感染（p = 1.00）、内固定失败（p = 0.154）、异位骨化（p = 0.132）和ASD（p = 0.315）的发生率相似。此外，两组的翻修率相似（p = 0.315）。两组之间术后Nurick评分中位数无显著差异（p = 1.00）。CDA队列中的NDI改善更大（p = 0.040）。
ACDF和CDA在并发症发生率和脊髓病症状改善方面在统计学上相似。然而，接受CDA的患者的患者报告结局指标优于接受ACDF的患者。
