Comparing ACDF Outcomes by Cervical Spine Level: A Single Center Retrospective Cohort Study.

IF 1.7 Q2 SURGERY
Davis Martin, Ryan Schroeder, Collin Toups, Clifton Daigle, Matthew Spitchley, Claudia Leonardi, Berje Shammassian, Amit K Bhandutia
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引用次数: 0

Abstract

Background: Previous research suggests a relationship between complications associated with anterior cervical discectomy and fusion and level involvement; however, there is limited research comparing postoperative outcomes of upper cervical fusions (UCFs) with middle-to-lower cervical fusions (MLCFs). This study aims to compare the outcomes of UCF with MLCF.

Methods: A retrospective medical record review was conducted on 835 anterior cervical discectomy and fusion patients from 2012 to 2022. Patients were classified as UCF, defined as inclusion of C3 to C4 disc space, or MLCF, defined as lacking C3 to C4 disc space. Demographics were compared using χ 2 or Fisher exact tests. Clinical characteristics were compared in univariable analysis using χ 2 tests, linear-mixed effects models, or generalized linear-mixed models depending on distribution. Significant pre- and intraoperative characteristics were included in multivariable models to minimize confounding.

Results: Of the 835 patients included, 562 underwent MLCF and 281 underwent UCF. Median follow-up time was 211 days for UCF and 200 days for MLCF. UCF led to a 1.5-day longer length of stay in both univariable (1.5 vs 3.1, P < 0.0001) and multivariable analysis (2.3 days [95% CI: 1.8, 3.0] vs 3.3 days [2.6, 4.2], P < 0.0001). MLCF patients reported symptom improvement or resolution more often than UCF patients (0.43 [95% CI: 0.30, 0.62] and 0.46 [95% CI: 0.30, 0.70]). Additionally, a significantly higher rate of dysphagia was reported in the UCF group on both univariate and multivariable analysis, respectively (1.72 [95% CI: 1.18, 2.49] and 1.66 [95%CI: 1.08, 2.56]).

Conclusions: To our knowledge, this is the first study to investigate the link between cervical fusion level and outcomes. UCF patients demonstrated greater rates of dysphagia, longer length of stay, and lower likelihood of improvement in neurological symptoms postoperatively both before and after controlling for differences in pre- and intraoperative characteristics.

Clinical relevance: This study highlights that UCFs may be associated with worse postoperative outcomes when compared to MLCFs, which can inform surgical decision-making and patient counseling.

Level of evidence: The study represents Level 3 evidence due to its retrospective design and potential biases, indicating a need for future prospective randomized controlled trials to validate these findings.

比较不同颈椎水平的 ACDF 结果:单中心回顾性队列研究
背景:以往的研究表明,颈椎前路椎间盘切除术和融合术的相关并发症与受累水平之间存在关系;然而,对上颈椎融合术(UCF)和中下颈椎融合术(MLCF)的术后效果进行比较的研究却很有限。本研究旨在比较 UCF 与 MLCF 的疗效:方法: 对 2012 年至 2022 年间的 835 例颈椎前路椎间盘切除术和融合术患者进行了回顾性病历审查。患者被分为UCF(定义为包含C3至C4椎间盘间隙)和MLCF(定义为缺乏C3至C4椎间盘间隙)。采用χ 2 或费雪精确检验比较人口统计学特征。在单变量分析中,根据分布情况使用χ 2 检验、线性混合效应模型或广义线性混合模型对临床特征进行比较。将重要的术前和术后特征纳入多变量模型,以尽量减少混杂因素:在纳入的 835 名患者中,562 人接受了 MLCF,281 人接受了 UCF。UCF 的中位随访时间为 211 天,MLCF 为 200 天。在单变量分析(1.5 vs 3.1,P < 0.0001)和多变量分析(2.3 天 [95% CI:1.8, 3.0] vs 3.3 天 [2.6, 4.2],P < 0.0001)中,超导可使住院时间延长 1.5 天。MLCF患者比UCF患者更常报告症状改善或缓解(分别为0.43 [95% CI:0.30, 0.62] 和0.46 [95% CI:0.30, 0.70])。此外,在单变量和多变量分析中,UCF 组出现吞咽困难的比例明显更高(1.72 [95% CI: 1.18, 2.49] 和 1.66 [95%CI: 1.08, 2.56]):据我们所知,这是第一项研究颈椎融合术水平与疗效之间关系的研究。在控制术前和术中特征差异前后,UCF 患者出现吞咽困难的比例更高,住院时间更长,术后神经症状改善的可能性更低:临床相关性:本研究强调,与MLCFs相比,UCFs可能与更差的术后结果相关,这可以为手术决策和患者咨询提供参考:证据等级:由于该研究采用回顾性设计,可能存在偏差,因此属于三级证据,表明今后需要进行前瞻性随机对照试验来验证这些发现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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