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Войти в исследования Neurosurgical focus · 2026
Is cervical disc arthroplasty noninferior to anterior cervical discectomy and fusion for cervical spondylotic myelopathy? A Spine CORe™ analysis of QOD data.
СтатьяНазвание и аннотация: Перевод в очереди
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Zeitouni Daniel, Matache Irina-Mihaela, Tahir Izza, Kentzinsky Hendrik von, Bisson Erica F, Potts Eric A, Alentado Vincent J, Foley Kevin T, Wang Michael Y, Fu Kai-Ming, Virk Michael S, Shaffrey Christopher I, Gottfried Oren N, Knightly John J, Meyer Scott, Park Paul, Upadhyaya Cheerag D, Yen Chun-Po, Chan Andrew K, Tumialán Luis M, Chou Dean, Uribe Juan S, Turner Jay D, Yee Timothy J, Haid Regis W, Mummaneni Praveen V, Bydon Mohamad, Asher Anthony L, McGirt Matthew J, Kim Paul K
Аннотация
OBJECTIVE: Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction, and anterior cervical discectomy and fusion (ACDF) is the gold standard treatment. Cervical disc arthroplasty (CDA) is a relatively novel, motion preserving alternative to ACDF. The aim of this study was to assess CDA versus ACDF in the surgical treatment of CSM at a 5-year follow-up.
METHODS: This study used the 14-site Spine CORe™ study group cervical module of the Quality Outcomes Database (QOD), which included 1085 patients. Baseline demographics, clinical variables, and surgical parameters were collected. Patient-reported outcome measures (PROMs) included the EQ-5D, Neck Disability Index (NDI), and numeric rating scale (NRS) for neck pain and arm pain. Of the 1085 patients, 22 patients who underwent CDA with baseline and 5-year follow-up PROMs data who met the inclusion/exclusion criteria were selected. Nearest-neighbor propensity score matching was performed using a 4:1 matching ratio. Five-year PROMs were compared between the CDA and ACDF groups using the 2-sample t-test for continuous variables. Multivariable linear regression was performed to identify predictors of 5-year myelopathy severity.
RESULTS: There were 1085 patients in the 14-site Spine CORe™ study group's QOD cervical module; 110 matched patients were analyzed, including 22 who underwent CDA (mean age 47.73 years) and 88 who underwent ACDF (mean age 48.89 years). The subcohort had 100% of PROMs data (NDI, NRS, EQ-5D, and mJOA) at the 5-year follow-up. There were no significant differences for 1- and 2-level operations between the CDA and ACDF groups (p = 0.34). There were no significant differences in 5-year PROMs between the two groups. Patients improved in each PROM category in both treatment groups when comparing baseline with 5-year PROMs. While the rate of reoperation at 5 years was higher in the ACDF group compared with the CDA group, there was no statistically significant difference (17.0% vs 9.1%, p = 0.52).
CONCLUSIONS: In appropriately selected patients with CSM, CDA can provide comparable outcomes to ACDF while preserving cervical motion.
METHODS: This study used the 14-site Spine CORe™ study group cervical module of the Quality Outcomes Database (QOD), which included 1085 patients. Baseline demographics, clinical variables, and surgical parameters were collected. Patient-reported outcome measures (PROMs) included the EQ-5D, Neck Disability Index (NDI), and numeric rating scale (NRS) for neck pain and arm pain. Of the 1085 patients, 22 patients who underwent CDA with baseline and 5-year follow-up PROMs data who met the inclusion/exclusion criteria were selected. Nearest-neighbor propensity score matching was performed using a 4:1 matching ratio. Five-year PROMs were compared between the CDA and ACDF groups using the 2-sample t-test for continuous variables. Multivariable linear regression was performed to identify predictors of 5-year myelopathy severity.
RESULTS: There were 1085 patients in the 14-site Spine CORe™ study group's QOD cervical module; 110 matched patients were analyzed, including 22 who underwent CDA (mean age 47.73 years) and 88 who underwent ACDF (mean age 48.89 years). The subcohort had 100% of PROMs data (NDI, NRS, EQ-5D, and mJOA) at the 5-year follow-up. There were no significant differences for 1- and 2-level operations between the CDA and ACDF groups (p = 0.34). There were no significant differences in 5-year PROMs between the two groups. Patients improved in each PROM category in both treatment groups when comparing baseline with 5-year PROMs. While the rate of reoperation at 5 years was higher in the ACDF group compared with the CDA group, there was no statistically significant difference (17.0% vs 9.1%, p = 0.52).
CONCLUSIONS: In appropriately selected patients with CSM, CDA can provide comparable outcomes to ACDF while preserving cervical motion.