Comparative Analysis Of The Effects Of Anterior Cervical Decompression Fusion And Anterior Cervical Disc Replacement On Adjacent Segment Disease

Objective To compare the clinical effect of anterior cervical decompression fusion(ACDF)and anterior cervical disc replacement(ACDR)in the treatment of single-segment cervical spondylosis,to investigate the difference between the two types of surgery leading to adjacent segment disease(ASD).Methods 289 cases of anterior cervical decompression and fusion(ACDF)and 66 cases of anterior cervical artificial disc replacement(ACDR)performed from 2015 to 2016 at Department of Neurosurgery of Xuanwu Hospital affiliated to Capital Medical University were reviewed.40 ACDF patients and 40 ACDR patients with complete preoperative and postoperative clinical and imaging data who meet the inclusion criteria were included: 1.Age distribution: 24 to 50 years;2.Single segment;3.Cervical spondylotic radiculopathy or myelopathy.Exclusion criteria: 1.Not included in the age distribution;2.Surgical intervention is required for multi-segment interstitial lesions;3.Sympathetic cervical spondylosis or vertebral artery type cervical spondylosis;4.Severe spinal stenosis combined with posterior longitudinal ligament calcification(OPLL);5.Cervical trauma patients;6.History of previous cervical surgery;7.Patients with severe cervical deformity or flexion and extension,rotational movement disorders.Postoperative clinical symptoms,cervical X-ray film(positive lateral position,double oblique position,hyperextensional flexion position),visual analogue scale(VAS)of the neck and upper extremities,Japanese Orthopaedic Association Scores(JOA),neck disability index(NDI),cervical lordosis angle and anterior-posterior height of intervertebral space were collected during the follow-up period.The differences between the ACDR group and the ACDF group were analyzed.The follow-up period was 10 months to 24 months.Result(1)The paired t-test was used to compare the preoperative and postoperative scores of VAS,JOA and NDI between the ACDF group and the ACDR group.The postoperative scores of both groups were significantly improved compared with those before surgery(P< 0.05).(2)The cervical lordosis angle and the anteroposterior height of the intervertebral space in the ACDF group and the ACDR group were statistically significantly(P<0.05)improved compared with the preoperative ones.(3)There was no significant change in the kyphosis angle of the X-ray films at the last follow-up in the two groups.Osteophyte formed adjacent to the surgery in 2 patients from ACDF group and 1 from ACDR group.5 patients from ACDF group and 4 patients from ACDR had cervical root symptoms and spinal cord compression symptoms in adjacent level.There was no significant difference in the number of cases of ASD symptoms after operation between the two groups(P>0.05).Conclusion 1.ACDF and ACDR are effective in the treatment of single-segment cervical spondylosis.2.During the two-year follow-up period,there was no significant difference in the incidence of adjacent spondylosis after single-segment cervical spondylosis treated by ACDF and ACDR.