Nassar Joseph E, Singh Manjot, Knebel Ashley, Perez-Albela Alejandro, Farias Michael J, Daher Mohammad, Basques Bryce, Diebo Bassel G, Daniels Alan H
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Spine J. 2025 Jun;25(6):1178-1187. doi: 10.1016/j.spinee.2024.12.012. Epub 2024 Dec 15.
The optimal timing at which patients should undergo Anterior cervical discectomy and fusion (ACDF) surgery to achieve the best outcomes has not been determined. Given that patients may experience delays in care and that insurance companies often require a minimum of 6 weeks of conservative treatment before surgery, it is essential to determine the impact of symptom duration on outcomes following ACDF.
To evaluate the impact of symptom duration on outcomes following ACDF surgery.
Systematic review and meta-analysis.
Medline, Embase and Cochrane Library were searched from inception through July 2, 2024 in accordance with the PRISMA guidelines. Data on Neck Disability Index (NDI), Visual Analogue Scale (VAS) for neck and arm pain, and Short Form-12 (SF-12) physical and mental component scores were extracted. Subgroup analyses were performed to compare the outcomes at 6-months, 12-months and 24-months cutoff time points. Mean differences with 95%CI were used for continuous data.
Nine studies comprising 1,511 patients (48.64% female) with a mean age of 50.56±9.88 years were included in this study. All patients achieved improvements in NDI, VAS, and SF-12 following ACDF. The amount of improvement decreased as symptom duration increased with patients experiencing greater than 24 months of symptoms experiencing statistically significantly less improvement in NDI (8.70 vs 18.93, p=.03), VAS Neck (1.95 vs 3.33, p=.003), and VAS Arm (1.74 vs 3.72, p<.001) in comparison to patients with less than 24 months of symptoms. There were no statistically significant differences in outcomes at the 6 and 12 months cut off points between cohorts.
Longer symptom duration is associated with worse outcomes compared to shorter symptom duration with statistically significant differences observed at the 24-month cutoff for NDI, VAS Arm, and VAS Neck scores. Patients with greater than 24 months of symptoms also failed to achieve clinically significant improvement in neck pain postoperatively. Given the lasting impact of disability and pain on patients, more studies should assess the impact of symptom duration on postoperative outcomes and at even shorter cut-off points.
目前尚未确定患者接受颈椎前路椎间盘切除融合术（ACDF）以获得最佳疗效的最佳时机。鉴于患者可能会出现治疗延迟，且保险公司通常要求在手术前至少进行6周的保守治疗，因此确定症状持续时间对ACDF术后疗效的影响至关重要。
评估症状持续时间对ACDF手术后疗效的影响。
系统评价与荟萃分析。
根据PRISMA指南，检索了从创刊至2024年7月2日的Medline、Embase和Cochrane图书馆。提取了颈部残疾指数（NDI）、颈部和手臂疼痛视觉模拟量表（VAS）以及简短健康调查问卷12项（SF-12）身体和心理成分得分的数据。进行亚组分析以比较6个月、12个月和24个月截止时间点的疗效。连续数据采用95%置信区间的均值差。
本研究纳入了9项研究，共1511例患者（女性占48.64%），平均年龄为50.56±9.88岁。所有患者在ACDF术后NDI、VAS和SF-12均有所改善。随着症状持续时间的增加，改善程度降低，症状持续超过24个月的患者在NDI（8.70对18.93，p = 0.03）、VAS颈部（1.95对3.33，p = 0.003）和VAS手臂（1.74对3.72，p < 0.001）方面的改善在统计学上显著低于症状持续时间少于24个月的患者。各队列在6个月和12个月截止点的疗效无统计学显著差异。
与较短的症状持续时间相比，较长的症状持续时间与较差的疗效相关，在24个月截止时，NDI、VAS手臂和VAS颈部评分存在统计学显著差异。症状持续超过24个月的患者术后颈部疼痛也未实现临床上的显著改善。鉴于残疾和疼痛对患者的持久影响，更多研究应评估症状持续时间对术后疗效的影响，以及在更短的截止时间点的影响。
