■回顾性队列研究。
■颈椎前路椎间盘切除术和融合术(ACDF)是诊断为患有或不患有脊髓病的颈椎退行性疾病的患者的常见外科手术。由于ACDF在这些适应症中的广泛使用,因此需要对患有和不患有脊髓病的患者进行ACDF的结局有透彻的了解。
■非ACDF方法在某些脊髓病变病例中取得了较差的结果。研究比较了不同手术的患者结果,但很少有人比较有关脊髓病变与非脊髓病变队列的结局。
■从2007年到2016年查询了MarketScan数据库,以识别≤65岁的成年患者。并使用国际疾病分类第9版和当前程序术语代码进行了ACDF。采用最近邻居倾向评分匹配来平衡患者的人口统计学特征和非脊髓病变队列之间的手术特征。
■在符合纳入标准的107,480名患者中,29,152(27.1%)被诊断为脊髓病。在基线,脊髓病患者的中位年龄较高(52岁vs.50年,p<0.001),他们的合并症负担较高(平均Charlson合并症指数,1.92vs.1.58;p<0.001)比没有脊髓病的患者高。患有脊髓病的患者在2年时更有可能接受手术翻修(比值比[OR],1.63;95%置信区间[CI],1.54-1.73)或在90天内重新入院(或,1.27;95%CI,1.20-1.34)。在患者队列匹配后,患有脊髓病的患者在2年内仍处于升高的再次手术风险(OR,1.55;95%CI,1.44-1.67)和术后吞咽困难(2.78%vs.1.68%,p<0.001)与没有脊髓病的患者相比。
■我们发现接受ACDF治疗的脊髓病患者在基线时的术后结局低于没有脊髓病的患者。在平衡队列中潜在的混杂变量后,脊髓病患者再次手术和再次入院的风险显著增加。这些结局差异主要是由接受1-2级融合治疗的脊髓病患者造成的.
METHODS: Retrospective cohort
study.
OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for patients diagnosed with cervical degenerative diseases with or without myelopathy. A thorough understanding of outcomes in patients with and without myelopathy undergoing ACDF is required because of the widespread utilization of ACDF for these indications.
BACKGROUND: Non-ACDF approaches achieved inferior outcomes in certain myelopathic cases. Studies have compared patient outcomes across procedures, but few have compared outcomes concerning myelopathic versus nonmyelopathic cohorts.
METHODS: The MarketScan database was queried from 2007 to 2016 to identify adult patients who were ≤65 years old, and underwent ACDF using the international classification of diseases 9th version and current procedural terminology codes. Nearest neighbor propensity-score matching was employed to balance patient demographics and operative characteristics between myelopathic and nonmyelopathic cohorts.
RESULTS: Of 107,480 patients who met the inclusion criteria, 29,152 (27.1%) were diagnosed with myelopathy. At baseline, the median age of patients with myelopathy was higher (52 years vs. 50 years, p <0.001), and they had a higher comorbidity burden (mean Charlson comorbidity index, 1.92 vs. 1.58; p <0.001) than patients without myelopathy. Patients with myelopathy were more likely to undergo surgical revision at 2 years (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.54-1.73) or are readmitted within 90 days (OR, 1.27; 95% CI, 1.20-1.34). After patient cohorts were matched, patients with myelopathy remained at elevated risk for reoperation at 2 years (OR, 1.55; 95% CI, 1.44-1.67) and postoperative dysphagia (2.78% vs. 1.68%, p <0.001) compared to patients without myelopathy.
CONCLUSIONS: We found inferior postoperative outcomes at baseline for patients with myelopathy undergoing ACDF compared to patients without myelopathy. Patients with myelopathy remained at significantly greater risk for reoperation and readmission after balancing potential confounding variables across cohorts, and these differences in outcomes were largely driven by patients with myelopathy undergoing 1-2 level fusions.