Fisher Kalin J, Blumenthal Scott L, Guyer Richard D, Zigler Jack E, Shellock Jessica L, Ohnmeiss Donna D
Texas Back Institute, Plano, Texas.
Center for Disc Replacement at Texas Back Institute, Plano, Texas.
Spine (Phila Pa 1976). 2025 Jun 20. doi: 10.1097/BRS.0000000000005437.
This was a retrospective study.
The purpose of the study was to determine the incidence and reasons of intraoperative conversion from planned cervical total disc replacement (TDR) to anterior cervical discectomy and fusion (ACDF).
TDR currently offers an alternative treatment with results similar or superior to ACDF. Once individual surgeons become comfortable using a device, they will typically expand indications for its use, however, patient safety must remain at the forefront. In order to reduce reoperations, surgeons must use strict selection criteria to determine which patients are most appropriate to receive TDR. Despite those criteria, situations may arise when surgeons convert from TDR to ACDF intraoperatively.
A comprehensive surgery log was reviewed to identify cases of planned TDR converted intraoperatively to ACDF. All cases were performed at a single institution by 28 attending surgeons beginning with the first case experience in November, 2003 and ending with cases performed in November, 2023. Retrospective chart review was performed to collect demographic data and determine reasons for conversion.
During the 20-year period, a total of 2,188 consecutive cases of planned TDR were examined. The total number of planned TDR levels was 2,939. The rate of intraoperative conversion of TDR to ACDF was 0.55% (12/2,188 cases), 95% confidence interval 0.30% - 0.90%. With respect to the number of operated levels, the intraoperative rate of conversion was 0.48% (14/2,939 levels), 95% confidence interval 0.30-0.80%.
There was a very low incidence of intra-operative conversion of cervical TDR to ACDF. However, surgeons performing this procedure should be prepared for the possibility of intraoperative conversion from TDR to ACDF and educate patients of this possibility.
这是一项回顾性研究。
本研究的目的是确定术中从计划的颈椎全椎间盘置换术（TDR）转为颈椎前路椎间盘切除融合术（ACDF）的发生率及原因。
TDR目前提供了一种替代治疗方法，其效果与ACDF相似或更优。一旦个别外科医生对使用一种器械感到得心应手，他们通常会扩大其使用指征，然而，患者安全必须始终放在首位。为了减少再次手术，外科医生必须使用严格的选择标准来确定哪些患者最适合接受TDR。尽管有这些标准，但外科医生在术中仍可能从TDR转为ACDF。
回顾一份全面的手术记录，以确定术中从计划的TDR转为ACDF的病例。所有病例均由28位主治外科医生在单一机构完成，始于2003年11月的首例手术，止于2023年11月的手术病例。进行回顾性病历审查以收集人口统计学数据并确定转换原因。
在这20年期间，共检查了2188例连续的计划TDR病例。计划TDR的节段总数为2939个。TDR术中转为ACDF的发生率为0.55%（12/2188例），95%置信区间为0.30% - 0.90%。就手术节段数量而言，术中转换率为0.48%（14/2939个节段），95%置信区间为0.30 - 0.80%。
颈椎TDR术中转为ACDF的发生率非常低。然而，实施该手术的外科医生应做好术中从TDR转为ACDF的准备，并告知患者这种可能性。
