Cage only or cage with plate fixation in anterior cervical discectomy and fusion surgery - analysis of a national multicenter dataset.

IF 4.9 1区医学 Q1 CLINICAL NEUROLOGY

Spine Journal Pub Date : 2024-12-09 DOI:10.1016/j.spinee.2024.12.004

Lovisa Gerdhem, Pavlos Vlachogiannis, Paul Gerdhem, Anna MacDowall

{"title":"Cage only or cage with plate fixation in anterior cervical discectomy and fusion surgery - analysis of a national multicenter dataset.","authors":"Lovisa Gerdhem, Pavlos Vlachogiannis, Paul Gerdhem, Anna MacDowall","doi":"10.1016/j.spinee.2024.12.004","DOIUrl":null,"url":null,"abstract":"Background context: Anterior Cervical Discectomy and Fusion (ACDF) is a surgical technique that can be used to treat several conditions of the cervical spine. Small sized studies have reported differences in radiological findings between cage only and cage with plate fusion techniques but no differences in clinical outcome, hence, larger studies are needed.Purpose: The aim of this study was to compare the outcomes of ACDF between cage only and cage with plate fixation.Study design: Retrospective study design on prospectively collected registry data.Patient sample: Individuals treated for cervical degenerative radiculopathy, with ACDF using either cage only or cage with plate fixation were identified in the Swedish Spine registry (Swespine). Included individuals had available baseline and 1-year postoperative data for the Numeric Rating Scale (NRS) for neck and arm pain.Outcome measures: Patient reported outcome measures (PROMs) included were NRS for neck and arm pain, Neck Disability Index (NDI), and EuroQol-Visual Analogue Scale (EQ-VAS). Complications reported by clinicians and patients were also available in the Swespine registry, as well as the degree of satisfaction at the 1-year follow-up.Methods: Outcomes at the 1-year follow-up were compared between the cage only or cage with plate groups. In a secondary analysis, one or two levels of surgery was compared between the groups. The number of patients that reached the Minimum Clinically Important Difference (MCID) in improvement after treatment was calculated and compared between the groups. The Mann Whitney-U test was used for continuous variables and the Chi2 test for categorical variables.Results: The groups included 344 individuals instrumented with cage only, and 334 receiving cage with plate fixation. NDI improvement was -14.0 points (95% CI: -12.2-[-15.8]) in the cage only group and -17.9 points (95% CI: -16.1 - [-19.8]) points in the cage with plate group (p=.007). A lower rate of hoarseness post-operatively was reported by the cage only group (OR: 0.65 [0.45-0.93], p=.026). No differences were seen in other outcomes.Conclusion: Clinical improvement was seen in both groups, but the improvement of NDI was better in the cage with plate group and the rate of hoarseness was lower in the cage only group.","PeriodicalId":49484,"journal":{"name":"Spine Journal","volume":" ","pages":""},"PeriodicalIF":4.9000,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.spinee.2024.12.004","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background context: Anterior Cervical Discectomy and Fusion (ACDF) is a surgical technique that can be used to treat several conditions of the cervical spine. Small sized studies have reported differences in radiological findings between cage only and cage with plate fusion techniques but no differences in clinical outcome, hence, larger studies are needed.

Purpose: The aim of this study was to compare the outcomes of ACDF between cage only and cage with plate fixation.

Study design: Retrospective study design on prospectively collected registry data.

Patient sample: Individuals treated for cervical degenerative radiculopathy, with ACDF using either cage only or cage with plate fixation were identified in the Swedish Spine registry (Swespine). Included individuals had available baseline and 1-year postoperative data for the Numeric Rating Scale (NRS) for neck and arm pain.

Outcome measures: Patient reported outcome measures (PROMs) included were NRS for neck and arm pain, Neck Disability Index (NDI), and EuroQol-Visual Analogue Scale (EQ-VAS). Complications reported by clinicians and patients were also available in the Swespine registry, as well as the degree of satisfaction at the 1-year follow-up.

Methods: Outcomes at the 1-year follow-up were compared between the cage only or cage with plate groups. In a secondary analysis, one or two levels of surgery was compared between the groups. The number of patients that reached the Minimum Clinically Important Difference (MCID) in improvement after treatment was calculated and compared between the groups. The Mann Whitney-U test was used for continuous variables and the Chi² test for categorical variables.

Results: The groups included 344 individuals instrumented with cage only, and 334 receiving cage with plate fixation. NDI improvement was -14.0 points (95% CI: -12.2-[-15.8]) in the cage only group and -17.9 points (95% CI: -16.1 - [-19.8]) points in the cage with plate group (p=.007). A lower rate of hoarseness post-operatively was reported by the cage only group (OR: 0.65 [0.45-0.93], p=.026). No differences were seen in other outcomes.

Conclusion: Clinical improvement was seen in both groups, but the improvement of NDI was better in the cage with plate group and the rate of hoarseness was lower in the cage only group.

查看原文本刊更多论文

颈椎前路椎间盘切除术和融合手术中仅使用椎笼或椎笼加钢板固定-国家多中心数据集分析。

背景背景：前路颈椎椎间盘切除术和融合术（ACDF）是一种可用于治疗多种颈椎疾病的外科技术。小型研究已经报道了单纯笼型和带钢板融合的笼型在放射学表现上的差异，但在临床结果上没有差异，因此需要更大规模的研究。目的：本研究的目的是比较单笼和带钢板固定的ACDF的结果。研究设计：前瞻性收集的登记数据的回顾性研究设计患者样本：在瑞典脊柱登记（Swespine）中确定了接受ACDF治疗的颈椎退行性神经根病患者，无论是使用单纯的cage还是使用钢板固定的cage。纳入的患者有可用的基线和1年术后颈部和手臂疼痛的数字评定量表（NRS）数据。结果测量：患者报告的结果测量（PROMs）包括颈部和手臂疼痛的NRS，颈部残疾指数（NDI）和EuroQol-Visual Analogue Scale （EQ-VAS）。临床医生和患者报告的并发症也可在Swespine注册表中获得，以及1年随访时的满意度。方法：比较单笼组和带钢板组1年随访结果。在二次分析中，对两组间的一级或二级手术进行比较。计算并比较两组治疗后达到最小临床重要差异（Minimum clinical Important Difference， MCID）的患者数量。对连续变量采用Mann Whitney-U检验，对分类变量采用Chi2检验。结果：组内344例只固定笼，334例接受钢板固定笼。单笼组NDI改善为-14.0分（95% CI: -12.2-[-15.8]），带钢板的笼组NDI改善为-17.9分（95% CI: -16.1 -[- 19.8]）（p = 0.007）。单笼组术后声音嘶哑率较低（OR: 0.65 [0.45-0.93], p = 0.026）。其他结果未见差异。结论：两组患者均有临床改善，但带钢板笼组NDI改善较好，单笼组沙哑率较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Spine Journal 医学-临床神经学

CiteScore

8.20

自引率

6.70%

发文量

680

审稿时长

13.1 weeks

期刊介绍： The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.