19.单水平颈椎间盘关节置换术与前路颈椎椎间盘切除术和融合术后的复发率：一项至少随访 5 年的观察性研究

Q3 Medicine

North American Spine Society Journal Pub Date : 2024-07-01 DOI:10.1016/j.xnsj.2024.100357

Adam M. Gordon MD , Faisal Elali BS, BA

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引用次数: 0

摘要

背景 CONTEX前瞻性研究比较了 CDA 和 ACDF 的患者报告结果、邻近节段退变和长期翻修情况。目的比较接受初级单水平颈椎间盘关节置换术（CDA）或前路颈椎椎间盘切除融合术（ACDF）的患者5年全因翻修率和风险因素。研究设计/背景回顾性病例对照观察研究。患者样本查询了 2010 年至 2021 年美国全国人口数据库中因颈椎退行性病变接受初级单水平 CDA 或 ACDF 手术的患者。方法将接受 CDA 治疗的患者与接受 ACDF 治疗的患者按年龄、性别、个人合并症和总的 Elixhauser 合并症指数 (ECI) 以 1:5 的比例进行配对。多变量逻辑回归模型用于计算初次手术后 5 年内进行翻修手术的几率比（OR），同时控制年龄、性别和包括 ECI 在内的各种合并症。结果经过成功的比值匹配，共有32953名患者接受了单层CDA（5640人）或ACDF（27313人），随访时间最短为5年。5 年内各种原因的翻修发生率，CDA 为 1.24%，ACDF 为 9.23%（P<0.001）。经调整后，接受单层 ACDF 的患者在 5 年内发生全因性翻修的几率明显更高（OR：8.09；P<0.0001）。与翻修相关的其他患者特异性因素包括药物滥用史（OR：1.51；P<0.0001）、抑郁症（OR：1.23；P<0.0001）、心律失常（OR：1.21；P=0.0008）、高血压（OR：1.20；P=0.结论在这项对近 33,000 例单层次颈椎手术进行了至少 5 年随访的观察性研究中，接受 CDA 的患者全因翻修率显著较低。外科医生可以利用这些数据，就全国范围内报告的单层 CDA 或 ACDF 5 年后的翻修率为患者提供咨询。FDA 器械/药物状态本摘要未讨论或包含任何适用的器械或药物。

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19. Revision rates after single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion: an observational study with 5-year minimum follow-up

BACKGROUND CONTEXT

Prospective studies have compared patient reported outcomes, adjacent segment degeneration, and long-term revisions between CDA and ACDF. Despite these high-level evidence studies, well-powered, large investigations have not been adequately reported.

PURPOSE

The aims were to compare rates and risk factors for all-cause 5-year revisions for patients undergoing primary single-level cervical disc arthroplasty (CDA) or Anterior Cervical Discectomy and Fusion (ACDF).

STUDY DESIGN/SETTING

Retrospective case-control observational study.

PATIENT SAMPLE

A nationwide United States population database from 2010 to 2021 was queried for patients undergoing primary single level CDA or ACDF for degenerative cervical spine pathology. Further inclusion criteria consisted of patients having a minimum of 5-year follow-up.

OUTCOME MEASURES

Objectives were to compare the rates of all-cause 5-year revisions for those undergoing single level CDA versus ACDF and assess the risk factors associated with requiring revision surgery.

METHODS

Patients undergoing CDA were 1:5 ratio matched to patients undergoing ACDF by age, sex, individual comorbidities, and overall Elixhauser comorbidity index (ECI). Multivariate logistic regression models were used to calculate odds ratios (OR) of revision surgery within 5 years of the primary procedure while controlling for age, sex, and individual comorbidities comprising the ECI. P values less than 0.001 were significant.

RESULTS

After successful ratio matching, a total of 32,953 patients underwent single level CDA (N=5,640) or ACDF (N=27,313) with 5-Year minimum follow-up. The incidence of all cause revision within 5 years was 1.24% for CDA and 9.23% for ACDF (P<0.001). After adjustment, patients undergoing single level ACDF has significantly higher odds of all-cause revisions within 5 years (OR: 8.09; P<0.0001). Additional patient specific factors associated with revisions were a history of reported drug abuse (OR: 1.51; P<0.0001), depression (OR: 1.23; P<0.0001), cardiac arrythmias (OR: 1.21; P=0.0008), hypertension (OR: 1.20; P=0.0006), and tobacco use (OR: 1.18; P=0.0003).

CONCLUSIONS

In this observational study of nearly 33,000 single level cervical spine surgeries with minimum 5-year follow-up, all-cause revision rates were significantly lower for patients undergoing CDA. Surgeons may use this data to counsel patients on nationwide reported revision rates up to 5-years from single level CDA or ACDF.