Gerdhem Lovisa, Vlachogiannis Pavlos, Gerdhem Paul, MacDowall Anna
Torsby Hospital, Torsby, Sweden; Department of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.
Department of Orthopaedics and Hand surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Spine J. 2025 May;25(5):947-955. doi: 10.1016/j.spinee.2024.12.004. Epub 2024 Dec 9.
Anterior Cervical Discectomy and Fusion (ACDF) is a surgical technique that can be used to treat several conditions of the cervical spine. Small sized studies have reported differences in radiological findings between cage only and cage with plate fusion techniques but no differences in clinical outcome, hence, larger studies are needed.
The aim of this study was to compare the outcomes of ACDF between cage only and cage with plate fixation.
Retrospective study design on prospectively collected registry data.
Individuals treated for cervical degenerative radiculopathy, with ACDF using either cage only or cage with plate fixation were identified in the Swedish Spine registry (Swespine). Included individuals had available baseline and 1-year postoperative data for the Numeric Rating Scale (NRS) for neck and arm pain.
Patient reported outcome measures (PROMs) included were NRS for neck and arm pain, Neck Disability Index (NDI), and EuroQol-Visual Analogue Scale (EQ-VAS). Complications reported by clinicians and patients were also available in the Swespine registry, as well as the degree of satisfaction at the 1-year follow-up.
Outcomes at the 1-year follow-up were compared between the cage only or cage with plate groups. In a secondary analysis, one or two levels of surgery was compared between the groups. The number of patients that reached the Minimum Clinically Important Difference (MCID) in improvement after treatment was calculated and compared between the groups. The Mann Whitney-U test was used for continuous variables and the Chi test for categorical variables.
The groups included 344 individuals instrumented with cage only, and 334 receiving cage with plate fixation. NDI improvement was -14.0 points (95% CI: -12.2-[-15.8]) in the cage only group and -17.9 points (95% CI: -16.1 - [-19.8]) points in the cage with plate group (p=.007). A lower rate of hoarseness postoperatively was reported by the cage only group (OR: 0.65 [0.45-0.93], p=.026). No differences were seen in other outcomes.
Clinical improvement was seen in both groups, but the improvement of NDI was better in the cage with plate group and the rate of hoarseness was lower in the cage only group.
颈椎前路椎间盘切除融合术（ACDF）是一种可用于治疗多种颈椎疾病的外科技术。小型研究报告了单纯椎间融合器与带钢板融合技术在影像学结果上存在差异，但临床结果并无差异，因此，需要开展更大规模的研究。
本研究旨在比较单纯椎间融合器与带钢板固定的ACDF手术效果。
对前瞻性收集的登记数据进行回顾性研究设计。
在瑞典脊柱登记处（Swespine）中确定了因颈椎退行性神经根病接受单纯椎间融合器或带钢板固定的ACDF治疗的个体。纳入的个体有颈部和手臂疼痛数字评定量表（NRS）的基线数据和术后1年的数据。
纳入的患者报告结局指标（PROMs）包括颈部和手臂疼痛的NRS、颈部功能障碍指数（NDI）和欧洲五维度健康量表视觉模拟量表（EQ-VAS）。临床医生和患者报告的并发症以及1年随访时的满意度在Swespine登记处也可获取。
比较单纯椎间融合器组和带钢板组1年随访时的结局。在二次分析中，比较两组之间一或两个节段的手术情况。计算并比较两组治疗后达到最小临床重要差异（MCID）改善的患者数量。连续变量采用曼-惠特尼U检验，分类变量采用卡方检验。
单纯椎间融合器组纳入344例患者，带钢板固定组纳入334例患者。单纯椎间融合器组NDI改善为-14.0分（95%CI：-12.
