Cervical disc arthroplasty for magnetic resonance–evident cervical spondylotic myelopathy: comparison with anterior cervical discectomy and fusion

作者：T.Y. Ko, Ching-Lan Wu, Hsuan-Kan Chang, Chih-Chang Chang, Yi‐Hsuan Kuo, Mei‐Yin Yeh, Chao‐Hung Kuo, Chin-Chu Ko, Li-Yu Fay, Tsung-Hsi Tu, Wen‐Cheng Huang, Jau‐Ching Wu · 发表于：Neurosurgical FOCUS · 年份：2023 · DOI：10.3171/2023.6.focus23291 · 被引用次数：5 · 研究领域：Cervical and Thoracic Myelopathy、Spine and Intervertebral Disc Pathology、Spinal Fractures and Fixation Techniques

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a standard surgical approach for cervical spondylotic myelopathy (CSM) caused by disc herniations. Although cervical disc arthroplasty (CDA) has become, in the past decade, a viable alternative to ACDF in selected patients, the differences among patients with CSM treated with CDA and ACDF remain elusive. The effectiveness of motion preservation devices in CSM is also unclear. METHODS: Adult patients who underwent 1- or 2-level CDA or ACDF between 2007 and 2021 were retrospectively reviewed. Patients whose preoperative T2-weighted MRI demonstrated increased intramedullary signal intensity (IISI) were included and analyzed for the following: comparison of the length of IISI on pre- and postoperative MR images as well as range of motion (ROM) at the indexed levels between the CDA and ACDF groups. Measurement for clinical outcomes included the visual analog scale (VAS) of the arm and neck, the Neck Disability Index, and modified Japanese Orthopaedic Association scores. Perioperative clinical data were also compared between the two groups. RESULTS: A total of 122 patients were allocated to the CDA group and 108 to the ACDF group, with mean follow-ups of 46.6 and 39.0 months, respectively. Patients in the CDA group were younger than those in the ACDF group (47.64 ± 12.40 vs 61.73 ± 12.25 years, p < 0.001) (mean ± SD). The ACDF group had more 2-level surgery compared to the CDA group (p = 0.002). Both groups had significan...