Artificial Disc Replacement Combined With Fusion Versus Two-Level Fusion in Cervical Two-Level Disc Disease
Artificial Disc Replacement Combined With Fusion Versus Two-Level Fusion in Cervical Two-Level Disc Disease
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DOI：
10.1097/brs.0b013e3181ba2a8d
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发表时间：
2009-05-15
期刊：
影响因子：
3
通讯作者：
Shin, Hyun Cheol
中科院分区：
文献类型：
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作者：
Shin, Dong Ah;Yi, Seong;Shin, Hyun Cheol
研究设计。前瞻性分析。目的。本研究的目的是比较颈椎人工椎间盘置换术（C-ADR）联合颈前路椎间盘切除术融合术（ACDF）和2节段ACDF治疗2节段颈椎间盘病变患者的临床和影像学结果。背景资料摘要。相邻节段退变是ACDF的长期并发症，估计有25%的患者在初次手术后10年内会受到影响。两节段融合术比一节段融合术导致椎间盘内压力显著增加。研究表明，C-ADR维持手术水平的运动，减少相邻节段的应变，防止相邻节段退变。对于2节段颈椎间盘疾病，混合手术（HS），由C-ADR联合ACDF组成，可能是2节段ACDF （2-ACDF）的合理选择。2004年至2006年，40例患者在我院接受了2节段颈椎椎间盘手术，符合以下手术指征：C3/4至C6/7间连续2节段椎间盘退行性病变；神经根病或脊髓病；保守治疗6周无反应。根据年龄和性别，将20例HS组患者与20例2-ACDF组患者进行配对。术前及术后常规间隔（1、3、6、12、24个月）检查患者的颈部失能指数（NDI）和疼痛强度分级。术前和术后常规间隔1、3、6、12和24个月分别在站立位下拍摄动态屈伸侧位颈椎x线片。采用Cobb法和PACS软件测量C2-C7及相邻节段的角运动范围（ROM）。HS组术后1、2年NDI恢复较好（P < 0.05）。HS组术后1个月、1年颈部疼痛明显减轻（P < 0.05）。两组之间手臂疼痛的缓解没有差异。HS组C2-C7 ROM恢复较快。HS组平均C2-C7 ROM恢复到术前水平，而2-ACDF组未恢复到术前水平（P < 0.05）。下邻段ROM在术后6、9个月、1、2年组间差异有统计学意义（P < 0.05、P < 0.01、P < 0.05、P < 0.05）。HS在更好的NDI恢复、更少的术后颈部疼痛、更快的C2-C7 ROM恢复和更少的相邻ROM增加方面优于2-ACDF。
Study Design. A prospective analysis.Objective. The purpose of this study was to compare the clinical and radiologic outcomes of cervical artificial disc replacement (C-ADR) combined with anterior cervical discectomy and fusion (ACDF) and 2-level ACDF in patients with 2-level cervical disc disease.Summary of Background Data. Adjacent segment degeneration is a long-term complication of ACDF, and estimated to affect 25% of patients within 10 years of the initial surgery. Two-level fusion leads to a substantially greater increase in intradiscal pressure than one-level fusion. It has been demonstrated that C-ADR maintains motion at the level of the surgical procedure and decreases strain on the adjacent segments for prevention of adjacent segment degeneration. In the case of 2-level cervical disc disease, hybrid surgery (HS), consisting of C-ADR combined with ACDF, may be a reasonable alternative to 2-level ACDF (2-ACDF).Methods. Between 2004 and 2006, 40 patients undergoing 2-level cervical disc surgery at our hospital were identified who met the following surgical indications: 2 consecutive level degenerative disc disease between C3/4 and C6/7; either a radiculopathy or myelopathy; and no response to conservative treatment for > 6 weeks. Twenty patients of the HS group were matched to 20 patients of the 2-ACDF group based on age and gender. Patients were asked to check the neck disability index (NDI) and grade their pain intensity before surgery and at routine postoperative intervals of 1, 3, 6, 12, and 24 months. Dynamic flexion and extension lateral cervical radiographs were obtained in the standing position before surgery and at routine postoperative intervals of 1, 3, 6, 12, and 24 months. The angular range of motion (ROM) for C2-C7 and adjacent segments were measured using the Cobb method with PACS software.Results. The HS group had better NDI recovery 1 and 2 years after surgery (P < 0.05). Postoperative neck pain was less in the HS group 1 month and 1 year after surgery (P < 0.05). There was no difference in arm pain relief between the groups. The HS group showed faster C2-C7 ROM recovery. The mean C2-C7 ROM of the HS group recovered to that of the preoperative value, but that of the 2-ACDF group did not (P < 0.05). The inferior adjacent segment ROM showed significant differences between the groups 6 and 9 months, and 1 and 2 years after surgery (P < 0.05, P < 0.01, P < 0.05, and P < 0.05, respectively).Conclusion. HS is superior to 2-ACDF in terms of better NDI recovery, less postoperative neck pain, faster C2-C7 ROM recovery, and less adjacent ROM increase.