Abstract:Objective〓To compare efficacy of anterior cervical discectomy and fusion(ACDF) and anterior cervical corpectomy and fusion(ACCF) in treatment of double-segmental cervical spondylosis.Methods〓102 patients underwent surgical treatment for double-segmental cervical spondylosis in Peoples’ Hospital of Huangshan City from January 2018 to June 2022 were retrospectively reviewed,and divided into ACDF group and ACCF group,according to surgical approach the patient received.ACDF group comprised 50 patients (22 males and 28 females),mean age of (54.78±10.22) years.ACCF group included 52 patients (40 males and 12 females),mean age of (56.06±10.32) years.Perioperative indexes,incidence rate of complications,excellent and good rate,visual analogue scale(VAS),Japan orthopaedic association(JOA) score,neck disability index(NDI),cervical Cobb angle,cervical range of motion(ROM),ROM of adjacent upper and caudal segments,incidence rate of adjacent segment degeneration(ASD) were compared between the two groups.Results〓There was no significant difference in preoperative VAS,JOA score,NDI between the two groups(P>0.05).Operation time,intraoperative blood loss,drainage volume,hospital stay and incidence rate of complications in ACDF group were significantly less than those in ACCF group(P<0.05).All of the patients were followed up for 15 to 22 months with a mean time of (18.23±1.50)months.VAS,JOA score,NDI improved significantly in both groups(P<0.05),but there was no significant difference in excellent and good rate,cervical ROM,ROM of adjacent upper and caudal segments and incidence rate of ASD between the two groups at final follow-up(P>0.05).The cervical Cobbangle in ACDF group was significantly larger than that in ACCF group(P<0.05).Conclusion〓Both ACDF and ACCF produce a satisfactory operative efficacy in treatment of double-segmental cervical spondylosis,improving cervical and nervous function.However,both two approaches may lead to complications and ASD,partly restrict cervical movement.Comparatively,ACDF is less invasive,causes fewer complications and maintains better cervical curvature.
汪心洋,汪颖峰,韩建邦,李毅,黄定安. 两种前路手术方式治疗相邻双节段颈椎病的疗效对比研究[J]. 实用骨科杂志, 2024, 30(8): 679-.
Wang Xinyang,Wang Yingfeng,Han Jianbang,Li Yi,Huang Dingan. Comparative Study on Efficacy in Treatment of Double-Segmental Cervical Spondylosis with Two Anterior Surgical Approaches. sygkzz, 2024, 30(8): 679-.
[1]中华外科杂志编辑部.颈椎病的手术治疗及围手术期管理专家共识(2018)[J].中华外科杂志,2018,56(12):881-884.
[2]Elsamadicy AA,Sumaiya S,Samuel C,et al.167 association between safety-net hospital status and postoperative outcomes following ACDF or PCDF for cervical spondylotic yelopathy[J].Neurosurgery,2024,70(Suppl_1):40.
[3]Wang T,Wang H,Liu S,et al.Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in multilevel cervical spondylotic myelopathy:A meta-analysis[J].Medicine (Baltimore),2016,95(49):e5437.
[4]李海东,张强华,何守玉,等.两种前路手术治疗相邻双节段脊髓型颈椎病中期并发症对比研究[J].浙江临床医学,2018,20(8):1351-1352;1355.
[5]Han YC,Liu ZQ,Wang SJ,et al.Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy?A systemic review and meta-analysis[J].PLOS ONE,2014,9(1):e87191.
[6]Arif H,Razzouk J,Bohen D,et al.Analysis of reasons for medical malpractice litigation due to anterior cervical discectomy and fusion[J].World Neurosurg X,2024(23):23100371.
[7]David AK,Nickolas M,Teja K,et al.Comparative and predictor analysis of 30-day readmission,Reoperation,and morbidity in patients undergoing multilevel ACDF versus single and multilevel ACCF using the ACS-NSQIP dataset[J].Spine,2019,44(23):E1379-E1387.
[8]Banno F,Zreik J,Alvi AM,et al.Anterior cervical corpectomy and fusion versus anterior cervical discectomy and fusion for treatment of multilevel cervical spondylotic myelopathy:Insights from a national registry[J].World Neurosurgery,2019(132):e852-e861.
[9]Qiu Y,Xie Y,Chen Y,et al.Adjacent two-level anterior cervical discectomy and fusion versus one-level corpectomy and fusion in cervical spondylotic myelopathy:Analysis of perioperative parameters and sagittal balance[J].Clin Neurol Neurosurg,2020(194):105919.
[10]Yijian Z,Hao L,Huilin Y,et al.Anterior cervical corpectomy and fusion versus discectomy and fusion for the treatment of two-level cervical spondylotic myelopathy:Analysis of sagittal balance and axial symptoms.[J].Int Orthop,2018,42(8):1877-1882.
[11]杨永波,朱振军,杨希望,等.两种颈前路手术方式治疗双节段颈椎病[J].中国矫形外科杂志,2016,24(7):594-597.
[12]中华外科杂志编辑部.颈椎病的分型、诊断及非手术治疗专家共识(2018)[J].中华外科杂志,2018,56(6):401-402.
[13]Odom GL,Finney W,Woodhall B.Cervical disk lesions[J].J Am Med Assoc,1958,166(1):23-28.
[14]Langley GB,Sheppeard H.The visual analogue scale:Its use in pain measurement[J].Rheumatol Int,1985,5(4):145-148.
[15]Fukui M,Chiba K,Kawakami M,et al.An outcome measure for patients with cervical myelopathy:Japanese orthopaedic association cervical myelopathy evaluation questionnaire (JOACMEQ):Part 1[J].J Orthop Sci,2007,12(3):227-240.
[16]Vernon H,Mior S.The neck disability index:A study of reliability and validity[J].J Manipulative Physiol Ther,1991(14):409-415.
[17]Kellgren JH,Lawrence JS.Radiological assessment of osteoarthrosis[J].Ann Rheum Dis,1957,16(4):494-502.
[18]孙英飞,蒋欣,移平.ACDF与ACCF手术治疗双节段脊髓型颈椎病的疗效比较[J].颈腰痛杂志,2020,41(1):117-118.
[19]Rao RD,Gourab K,David KS.Operative treatment of cervical spondylotic myelopathy[J].J Bone Joint Surg (Am),2006,88(7):1619-1640.
[20]Xue HH,Tang D,Zhao WH,et al.Static mechanical analysis of the vertebral body after modified anterior cervical discectomy and fusion (partial vertebral osteotomy):A finite element model[J].J Orthop Surg Res,2023,18(1):554.
[21]陈恩良,王楠,全仁夫.两种颈前路减压融合术治疗两节段脊髓型颈椎病的疗效分析[J].中国骨伤,2020,33(9):841-847.
[22]Garcia D,Akinduro OO,Biase DG,et al.Single-photon emission computed tomography (SPECT-CT) as a predictor of pain generators in patients undergoing anterior cervical discectomy and fusion (ACDF) for axial cervical pain[J].Cureus,2024,16(4):e58821.
[23]方勤,周骏武,魏建军.单节段ACCF与两节段ACDF治疗相邻两节段脊髓型颈椎病疗效对比观察[J].山东医药,2019,59(20):65-68.
[24]Lin Q,Zhou X,Wang X,et al.A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylitic myelopathy[J].Eur Spine J,2012,21(1):474-481.
[25]白一冰,王岩,肖嵩华,等.颈椎病前路择期手术早期并发症危险因素分析[J].中国矫形外科杂志,2005,13(1):9-13.
[26]Du W,Wang HX,Lv J,et al.Cervical alignment and clinical outcome of anterior cervical discectomy and fusion vs.anterior cervical corpectomy and fusion in local kyphotic cervical spondylotic myelopathy[J].Heliyon,2023,9(8):e19106.
[27]Giorgio L,Sokol T,Alba S,et al.Two-level corpectomy and fusion vs.three-level anterior cervical discectomy and fusion without plating:Long-term clinical and radiological outcomes in a multicentric retrospective analysis[J].Life (Basel,Switzerland),2023,13(7):1564.
[28]黄定安,汪颖峰,詹文豪,等.不同颈椎前路手术治疗颈椎病对颈椎矢状面平衡参数的影响[J].皖南医学院学报,2023(6):554-556.
[29]Wang B,Lu G,Kuang L.Anterior cervical discectomy and fusion with stand-alone anchored cages versus posterior laminectomy and fusion for four-level cervical spondylotic myelopathy:A retrospective study with 2-year follow-up[J].BMC Musculoskelet Disord,2018,19(1):216.
[30]Ho DL,Sehan P,Sung CL,et al.Vertebral body sliding osteotomy as a surgical strategy for the treatment of cervical myelopathy:Outcomes at minimum 5 years follow-up[J].Spine,2023,48(9):600-609.
[31]Campion C,Crawford CH 3rd,Glassman SD,et al.Correction and maintenance of cervical alignment:3-level ACDF versus corpectomy-ACDF “Hybrid” procedures[J].Clin Spine Surg,2023,36(4):E118-E122.
[32]蒋登学,刘壮,施建锋,等.ACDF与ACCF治疗颈椎病术后内植物沉降的观察[J].颈腰痛杂志,2021,42(5):651-653,656.
[33]Matsumoto M,Okada E,Ichihara D,et al.Anterior cervical decompression and fusion accelerates adjacent segment degeneration:Comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study[J].Spine,2010,35(1):36-43.
[34]唐鹏宇,杨海源,罗勇骏,等.颈前路椎体次全切除术与椎间隙减压植骨融合术治疗邻近双节段颈椎病的临床疗效[J].江苏医药,2015,41(16):1920-1922.