植入物选择是否重要？三节段颈椎前路椎间盘切除融合术采用独立锚定 cage 与钢板-cage 系统的临床和影像学结果。

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中文摘要

背景： 颈椎前路椎间盘切除融合术（ACDF）仍是多节段退变性脊髓型颈椎病的金标准手术治疗。虽然前路钢板-cage（PC）结构传统上用于增强稳定性和前凸，但其与软组织剥离增加和钢板相关并发症相关。独立锚定 cage（SAAC）系统已成为一种低切迹替代方案，在单节段和双节段疾病中疗效已得到证实；然而，支持其用于三节段连续 ACDF 的证据仍然有限。
目的： 比较使用 SAAC 与传统 PC 结构进行三节段 ACDF 的临床、影像学和围手术期结果。
方法： 对 2017 年至 2024 年间在 2 个三级中心接受三节段连续 ACDF 的 50 例患者进行回顾性比较研究。25 例患者接受 SAAC，25 例接受 PC 结构。在术前及术后长达 24 个月评估临床结果（视觉模拟量表、颈部功能障碍指数和改良日本骨科协会评分）和影像学参数（节段对线、C2-C7 前凸、节段高度和融合率）。使用混合效应模型调整基线差异。
结果： SAAC 组患者年龄显著更大，心血管合并症更多。尽管如此，SAAC 与更短的手术时间和更低的失血量相关（均 P < 0.05）。两组在 2 年时疼痛、神经功能和功能障碍方面均取得相当且有临床意义的改善。调整基线因素后，影像学结果包括对线矫正、高度维持、沉降和融合率相似。并发症特征，包括吞咽困难和植入物相关事件，在两组间无显著差异。
结论： 在三节段 ACDF 中，SAAC 结构在 2 年时提供与 PC 系统相当的临床和影像学结果，同时具有显著的围手术期优势。SAAC 即使在年龄更大、合并症更多的患者中也表现稳健，支持其作为多节段颈椎退变性疾病安全有效替代方案的作用。
临床相关性： 对于三节段 ACDF，独立锚定 cage 可被视为钢板-cage 结构的替代方案，提供更短的手术时间和更低的失血量，且 2 年临床和影像学结果相似。
证据等级： 3 级。

英文摘要

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) remains the gold-standard surgical treatment for multilevel degenerative cervical myelopathy. While anterior plate-cage (PC) constructs have traditionally been used to enhance stability and lordosis, they are associated with increased soft-tissue dissection and plate-related complications. Standalone anchored cage (SAAC) systems have emerged as a lower-profile alternative with proven efficacy in single- and 2-level disease; however, evidence supporting their use in 3-level contiguous ACDF remains limited.
OBJECTIVE: To compare the clinical, radiological, and perioperative outcomes of 3-level ACDF performed using SAAC vs conventional PC constructs.
METHODS: A retrospective comparative study was conducted on 50 patients who underwent 3-level contiguous ACDF between 2017 and 2024 at 2 tertiary centers. Twenty-five patients received SAAC, and 25 received PC constructs. Clinical outcomes (visual analog scale, Neck Disability Index, and modified Japanese Orthopedic Association) and radiological parameters (segmental alignment, C2-C7 lordosis, segmental height, and fusion rates) were assessed preoperatively and up to 24 months postoperatively. Mixed-effects modeling was used to adjust for baseline differences.
RESULTS: Patients in the SAAC group were significantly older and had higher cardiovascular comorbidity. Despite this, SAAC was associated with shorter operative time and lower blood loss (both P < 0.05). Both groups achieved comparable and clinically meaningful improvements in pain, neurological function, and disability at 2 years. Radiological outcomes, including alignment correction, height maintenance, subsidence, and fusion rates, were similar after adjustment for baseline factors. Complication profiles, including dysphagia and implant-related events, did not differ significantly between groups.
CONCLUSIONS: In 3-level ACDF, SAAC constructs provide clinical and radiological outcomes comparable to PC systems at 2 years while offering significant perioperative advantages. SAAC performed robustly even in older, more comorbid patients, supporting its role as a safe and effective alternative for multilevel cervical degenerative disease.
CLINICAL RELEVANCE: Standalone anchored cages may be considered an alternative to plate-cage constructs for 3-level ACDF, offering shorter operative time and lower blood loss with similar clinical and radiological outcomes at 2 years.
LEVEL OF EVIDENCE: Level 3.