Satin Alexander M, Shenker Tara, Guyer Richard D, Blumenthal Scott L, Zigler Jack E, Shellock Jessica L, Derman Peter B, Ohnmeiss Donna D, Rogers-LaVanne Mary P
Texas Back Institute, Plano, TX.
Nova Southeastern University College of Osteopathic Medicine, Davie, FL.
Spine (Phila Pa 1976). 2025 Feb 15;50(4):243-251. doi: 10.1097/BRS.0000000000005215. Epub 2024 Nov 13.
A retrospective chart review was conducted at a single institution.
The purpose of this study was to investigate the clinical outcomes of cervical disc arthroplasty (CDA) used for the treatment of symptomatic adjacent segment disease (ASD) developed after anterior cervical discectomy and fusion (ACDF).
A major clinical concern following ACDF is the development of ASD. ASD after ACDF is often treated with an additional fusion, but risks include pseudoarthrosis and further ASD. CDA is a motion-preserving alternative that addresses these concerns, and therefore, has been proposed as an alternative treatment for ASD after ACDF.
Patients who underwent CDA at level(s) adjacent to a prior ACDF (n = 120) were identified from a consecutive series of patients who underwent CDA at one institution. Pre-CDA to post-CDA patient-reported outcome measures were compared using the paired Wilcoxon signed-rank test.
A total of 142 devices were implanted-98 patients underwent a 1-level CDA, and 22 patients underwent a 2-level CDA. The mean follow-up duration after CDA was 32.11 months. Neck pain, arm pain, and Neck Disability Index scores significantly improved from the preoperative to postoperative time point (respectively: 6.14-3.02, 4.42-1.61, 44.28-28.62, all P < 0.001). In total, 7 patients underwent reoperation (5.83%). One of these patients underwent reoperation for pseudarthrosis at the level of ACDF following a hybrid procedure. The indications for index level reoperations (n = 3) were foraminal stenosis, osteolysis, and postoperative hematoma. All patients with an adjacent level reoperation (n = 3) received surgery at levels adjacent to the prior fusion, not the more recent CDA.
The results of this study found that CDA was effective for the treatment of ASD following ACDF. CDA appears to be a viable treatment option for ASD after ACDF in appropriately selected patients.
在单一机构进行回顾性病历审查。
本研究旨在调查颈椎间盘置换术（CDA）用于治疗颈椎前路椎间盘切除融合术（ACDF）后出现的症状性相邻节段疾病（ASD）的临床疗效。
ACDF术后的一个主要临床问题是ASD的发生。ACDF术后的ASD通常采用额外的融合术治疗，但风险包括假关节形成和进一步的ASD。CDA是一种保留运动功能的替代方法，可解决这些问题，因此，已被提议作为ACDF术后ASD的替代治疗方法。
从在一个机构接受CDA的连续系列患者中识别出在先前ACDF相邻节段接受CDA的患者（n = 120）。使用配对Wilcoxon符号秩检验比较CDA术前至术后患者报告的结局指标。
共植入142个器械——98例患者接受了单节段CDA，22例患者接受了双节段CDA。CDA后的平均随访时间为32.11个月。从术前到术后时间点，颈部疼痛、手臂疼痛和颈部功能障碍指数评分均显著改善（分别为：6.14 - 3.02、4.42 - 1.61、44.28 - 28.62，均P < 0.001）。共有7例患者接受了再次手术（5.83%）。其中1例患者在混合手术后因ACDF节段假关节形成接受了再次手术。初次手术节段再次手术的指征（n = 3）为椎间孔狭窄、骨质溶解和术后血肿。所有相邻节段再次手术的患者（n = 3）均在先前融合节段相邻水平接受手术，而非最近的CDA节段。
本研究结果发现，CDA对治疗ACDF术后的ASD有效。对于适当选择的患者，CDA似乎是ACDF术后ASD的可行治疗选择。
