Study Design: 

Longitudinal observational comparative cohorts.

Objective: 

The objective of this study is to compare 3 and 12-month radiographic sagittal parameters and patient-reported outcomes (PROs) in patients who underwent 3-level ACDF or a hybrid procedure.

Summary of Background Data: 

Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), and hybrids (combination ACCF-ACDF) are common procedures used to treat symptomatic cervical spondylosis. Although there is a relative abundance of literature comparing 1-level ACCF versus 2-level ACDF and 2-level ACCF versus 3-level ACDF, detailed comparisons of 3-level ACDF versus hybrid procedures have not been extensively addressed.

Methods: 

Patients who underwent a 3-Level ACDF (3L-ACDF, N=47) or 1-Level Corpectomy/1-Level ACDF (Hybrid, N=52) with at least a 12-month post-op data available were identified. Standard demographic, surgical and PROs were collected in addition to preoperative and postoperative radiographic data, including C2 plumb line (C2PL), C2–C7 lordosis (CL), segmental lordosis (SL), and T1 slope (T1S).

Results: 

The 2 cohorts were similar in terms of demographics. At 3 months post-op, CL (9.04° vs. −2.12°, P=0.00) and SL (6.06° vs. −2.26°, P=0.003) were significantly greater in the 3L-ACDF group versus the HYBRID group. This significant difference was maintained at 12 months postoperative for CL [(6.62° vs. −0.60°, P=0.015) but not for SL (2.36° vs. −1.09°, P=0.199)]. There were no differences in PROs between the 2 groups before surgery, at 3 months postoperative or 12 months postoperative. Seven patients required revision surgery in the 1-year study period (1 in the 3L-ACDF, and 6 in the Hybrid P<0.001).

Conclusions: 

Three level ACDF resulted in greater C2–C7 lordosis and segmental lordosis postoperatively, which was maintained at 1 year for cervical lordosis. While PROs were similar between the groups, patients with hybrid instrumentation required significantly more revision surgeries than those treated with 3-level ACDF.

中文翻译：

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宫颈排列的矫正和维持：3 级 ACDF 与椎体切除术-ACDF“混合”手术

学习规划： 

纵向观察比较队列。

客观的： 

本研究的目的是比较接受 3 级ACDF或混合手术的患者的 3 个月和 12 个月放射学矢状参数和患者报告结果 (PRO)。

背景数据摘要： 

颈前路椎间盘切除融合术( ACDF )、颈椎前路椎体切除融合术 (ACCF) 以及混合术（ACCF- ACDF组合）是用于治疗症状性颈椎病的常见手术。尽管比较 1 级 ACCF 与 2 级ACDF以及 2 级 ACCF 与 3 级ACDF的文献相对丰富，但 3 级ACDF与混合程序的详细比较尚未得到广泛讨论。

方法： 

确定了接受 3 级ACDF（3L- ACDF，N=47）或 1 级椎体切除术/1 级ACDF（混合，N=52）且至少有 12 个月术后可用数据的患者。除了术前和术后放射学数据外，还收集了标准人口统计学、手术和 PROs，包括 C2 铅垂线 (C2PL)、C2–C7 脊柱前凸 (CL)、节段性脊柱前凸 (SL) 和 T1 斜率 (T1S)。

结果： 

这两个队列的人口统计数据相似。术后 3 个月时， 3L- ACDF组的 CL（9.04° vs. -2.12°， P = 0.00）和 SL（6.06° vs. -2.26°，P = 0.003）显着高于HYBRID 组。CL 术后 12 个月仍保持这种显着差异[（6.62° vs. -0.60°，P = 0.015），但 SL 则没有（2.36° vs. -1.09°，P = 0.199）]。两组术前、术后3个月或术后12个月的PROs没有差异。在 1 年研究期间，7 名患者需要进行翻修手术（3L- ACDF中 1 名，Hybrid 中 6 名P <0.001）。

结论： 

三级ACDF导致术后C2-C7前凸和节段前凸更大，颈椎前凸维持1年。虽然各组之间的 PRO 相似，但使用混合器械的患者比使用 3 级ACDF治疗的患者需要更多的翻修手术。