A comparison of anterior cervical discectomy and fusion versus fusion combined with cervical disc replacement for treating multi-level cervical spondylotic disease / 国际外科学杂志

ABSTRACT

Objective To evaluate the clinical efficacy of hybrid surgery,which combines fusion with cervical disc replacement (CDR),compared to anterior cervical discectomy and fusion (ACDF) in patients with multi-level cervical spondylosis.Methods From January 2015 to March 2017,the clinical data of 53 patients with multi-level cervical spondylosis admitted to Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University,were retrospectively analyzed.They were divided into anterior cervical discectomy and fusion group (ACDF) (n =29) and hybrid surgery group (n =24) according to different operative methods.The operation time and intraoperative bleeding were analysised.Visual analogue scale (VAS) score,neck disability index (NDI),Japanese orthopaedic association (JOA) scores,Odom criteria and surgical complications were evaluated when outpatient reviewed for 1,3 and 6 months postoperative.The cervical range of motion (ROM),and adjacent segments degeneration (ASD) were assessed with radiographs.The measurement data of normal distribution were expressed as ((x) ± s),the comparison between groups was conducted by independent sample t test,and the repeated measurement data were analyzed by variance analysis.Counting data were expressed as percentage (％) and intergroup comparisons were performed by x2 test or Fisher exact test,and inter-group comparisons of classified data were performed by Kruskal-Wallis H (K) rank test.Results The operation time [(81.0 ± 15.4) min] and the amount of bleeding [(69.0 ± 38.4) ml] in the hybrid surgery group were less,but there was no statistical difference (t =1.487,1.065,P =0.154,0.301).Compared with postoperative complications,dysphagia occurred in 19 patients (65.5％) in group ACDF,which was significantly higher than 5 in group hybrid surgery (20.8％),but there was no significant difference in overall complications (x2 =9.759,P =0.082).Significant improvements in VAS score,NDI score and JOA score were observed postoperation in ACDF and hybrid surgery group,but there was no significant difference between the two groups (Fintra-group =31.225,70.358,32.412,P =0.000,0.000,0.000;Finter-group =1.258,2.451,0.914,P =0.277,0.135,0.352).There was no significant difference in Odom criteria between the two groups (x2 =260.500,P =0.077).The ROM of C3-C7 in group ACDF decreased significantly,while that in group hybrid surgery was not significantly decreased (t =2.514,1.776,P =0.022,0.093).The ROM of C3-C7 was significantly different at 6 months postoperation (t =2.353,P =0.030).Although no ASD changes were found in the hybrid surgery group during the follow-up period,there was no significant statistical significance in the two groups (x2 =2.632,P =0.105).Conclusion Compared with the previous ACDF operation,there is no significant difference in the clinical results of hybrid surgery operation for multilevel cervical spondylosis,but it can effectively preserve cervical ROM,reduce adjacent segment degeneration and postoperative dysphagia.