Asada Tomoyuki, Subramanian Tejas, Araghi Kasra, Hahn Zora, Hirase Takashi, Bay Annika, Tuma Olivia, Zhao Eric R, Ehrlich Adin M, Halayqeh Sereen, Sandhu Harvinder S, Albert Todd J, Kim Han Jo, Farmer James C, Huang Russel C, Cunningham Matthew, Lovecchio Francis C, Dowdell James E, Iyer Sravisht, Qureshi Sheeraz A
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Global Spine J. 2025 May 7:21925682251338799. doi: 10.1177/21925682251338799.
Study DesignRetrospective cohort study.ObjectivesSevere neck pain has traditionally been considered a relative contraindication for cervical disc replacement (CDR) due to risk of persistent neck pain from the remaining mobile segment. However, recent studies suggest potential for neck pain improvement with CDR. This study aimed to compare postoperative improvements in neck pain and disability between patients undergoing anterior cervical discectomy and fusion (ACDF) and CDR.MethodsPredominant neck pain was defined as neck pain equal to or greater than arm pain preoperatively (visual analog scale [VAS]) and neck disability index (NDI) > 20. Patients with predominant neck pain who underwent 1- or 2-level ACDF or CDR for radiculopathy between 2017 and 2023 were included. Patient-reported outcomes (NDI, VAS) were assessed up to 1 year postoperatively. Inverse probability of treatment weighting (IPTW) was used to control for confounders. Linear mixed-effect models were applied to compare postoperative outcomes.ResultsA total of 179 patients (105 ACDF, 74 CDR) were included. Both groups showed significant improvement in NDI and VAS neck scores from baseline to 1 year (NDI: β = -1.81, < .001; VAS neck: β = -.26, < .001). After IPTW, no significant differences were found between ACDF and CDR across all PROMs up to 1 year (NDI: β = -0.44, = .09; VAS neck: β = -.07, = .10).ConclusionCDR was associated with postoperative improvements in neck pain and disability comparable to those observed with ACDF in patients with predominant neck pain and radiculopathy. These findings suggest that CDR may be a reasonable treatment option for selected patients.
研究设计
回顾性队列研究。
目的
由于剩余活动节段存在持续性颈部疼痛的风险，严重颈部疼痛传统上被视为颈椎间盘置换术（CDR）的相对禁忌证。然而，最近的研究表明CDR有改善颈部疼痛的潜力。本研究旨在比较接受颈椎前路椎间盘切除融合术（ACDF）和CDR的患者术后颈部疼痛和功能障碍的改善情况。
方法
主要颈部疼痛定义为术前颈部疼痛等于或大于手臂疼痛（视觉模拟量表[VAS]）且颈部功能障碍指数（NDI）>20。纳入2017年至2023年间因神经根病接受1或2节段ACDF或CDR的主要颈部疼痛患者。术后长达1年评估患者报告的结局（NDI、VAS）。采用治疗权重逆概率（IPTW）来控制混杂因素。应用线性混合效应模型比较术后结局。
结果
共纳入179例患者（105例ACDF，74例CDR）。两组从基线到1年时NDI和VAS颈部评分均有显著改善（NDI：β = -1.81，P <.001；VAS颈部：β = -.26，P <.001）。IPTW后, 至1年时ACDF和CDR在所有患者报告结局指标上均未发现显著差异（NDI：β = -0.44，P = .09；VAS颈部：β = -.07，P = .10）。
结论
对于主要颈部疼痛和神经根病患者，CDR术后颈部疼痛和功能障碍的改善与ACDF相当。这些发现表明CDR可能是部分患者的合理治疗选择。
