Objective: To investigate the influence of preoperative symptom duration on effectiveness of cervical disc arthroplasty (CDA) in cervical spondylotic radiculopathy (CSR) patients.
Methods: The clinical data of 90 CSR patients who underwent single-segment CDA between January 2008 and March 2020 and met the selection criteria were retrospectively analyzed. Based on preoperative symptom duration, patients were divided into an early intervention group (preoperative symptom duration <24 months) and a late intervention group (preoperative symptom duration ≥24 months). There was no significant difference in baseline data between the two groups ( P>0.05), including age, gender, body mass index, smoking status, surgical segment, preoperative neck disability index (NDI), visual analogue scale (VAS) score, cervical lordosis (CL), C 2-C 7 range of motion (ROM), disc angle (DA), disc ROM (DROM), and disc intervertebral height (DIH). The early intervention group had a slightly higher preoperative Japan Orthopedic Association (JOA) score than the late intervention group ( P<0.05). Perioperative indicators such as operation time, intraoperative blood loss, and postoperative hospital stay were recorded. The changes of JOA score, NDI, and VAS score at last follow-up compared with those before operation were used to evaluate the clinical efficacy, and the imaging evaluation of CL, C 2-C 7 ROM, DA, DROM, and DIH was performed before operation, immediately after operation, and at last follow-up. The incidence of prosthesis-related complications, including heterotopic ossification (HO), anterior bone loss (ABL), and prosthesis subsidence, was also assessed at last follow-up.
Results: Patients in both groups were followed up 24-120 months, with an average of 53.4 months. There was no significant difference in operation time, intraoperative blood loss, or follow-up duration between the groups ( P>0.05). However, the late intervention group had significantly longer postoperative hospital stay compared to the early intervention group ( P<0.05). At last follow-up, there was no significant difference in the changes of JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). During the follow-up, there was no surgical revision in the two groups, and there was no significant difference in the incidence of HO, ABL, and prosthesis subsidence between the two groups at last follow-up ( P>0.05). Imaging evaluation showed that there was no significant difference in CL, C 2-C 7 ROM, DA, DROM, and DIH between the two groups at each time point before and after operation ( P>0.05). The intra-group comparison showed that the early intervention group could maintain the immediate postoperative CL at last follow-up, while the late intervention group had recovered to the preoperative level. Additionally, the C 2-C 7 ROM, DROM, and DA had all recovered to preoperative levels at last follow-up in both groups; meanwhile, the DIH significantly increased immediately after operation and sustained until the last follow-up.
Conclusion: Preoperative symptom duration significantly affects the effectiveness of CDA in CSR patients. Patients with preoperative symptom duration ≥24 months have longer postoperative hospital stays and potentially poorer ability to maintain CL compared with patients with preoperative symptom duration <24 months.
目的: 探究术前症状持续时间对神经根型颈椎病（cervical spondylotic radiculopathy，CSR）患者行人工颈椎间盘置换术（cervical disc arthroplasty，CDA）后疗效的影响。.
方法: 回顾性分析2008年1月—2020年3月行单节段CDA且符合选择标准的90例CSR患者临床资料，根据术前症状持续时间分为早期干预组（59例，术前症状持续时间<24个月）和晚期干预组（31例，术前症状持续时间≥24个月）。两组患者年龄、性别、身体质量指数、吸烟状况、手术节段及术前颈部功能障碍指数（NDI）、疼痛视觉模拟评分（VAS）、颈椎曲度（cervical lordosis，CL）、C 2～C 7活动度（range of motion，ROM）、置换节段角（disc angle，DA）、置换节段ROM（disc ROM，DROM）、置换节段间隙高度（disc intervertebral height，DIH）等基线资料比较差异均无统计学意义（ P>0.05）；术前早期干预组日本骨科协会（JOA）评分略高于晚期干预组（ P<0.05）。记录并比较两组手术时间、术中出血量、术后住院时间等围术期指标；采用末次随访时JOA评分、NDI及VAS评分较术前的变化值评价临床疗效，采用术前、术后即刻及末次随访时的CL、C 2～C 7 ROM、DA、DROM、DIH进行影像学评估；末次随访时，评估假体相关并发症发生情况，包括异位骨化（heterotopic ossification，HO）、椎体前缘骨吸收（anterior bone loss，ABL）及假体下沉。.
结果: 术后两组患者均获随访，随访时间24～120个月，平均53.4个月。两组手术时间、术中出血量、随访时间比较差异均无统计学意义（ P>0.05）；晚期干预组术后住院时间长于早期干预组（ P<0.05）。末次随访时，两组患者JOA评分、NDI及VAS评分的手术前后变化值比较差异均无统计学意义（ P>0.05）。随访期间两组均未出现手术翻修者，末次随访时两组HO、ABL及假体下沉发生情况比较差异均无统计学意义（ P>0.05）。影像学评估示，手术前后各时间点两组间CL、C 2～C 7 ROM、DA、DROM、DIH差异均无统计学意义（ P>0.05）。组内比较示，早期干预组末次随访时尚能维持术后即刻的CL，而晚期干预组CL已恢复术前水平；两组患者C 2～C 7 ROM、DROM及DA在末次随访时均恢复至术前水平，DIH在术后即刻均显著增大，并维持至末次随访。.
结论: 术前症状持续时间对CSR患者CDA术后疗效具有显著影响，与术前症状持续时间<24个月患者相比，≥24个月者术后住院时间更长，CL的维持能力可能更差。.
Keywords: Preoperative symptom duration; cervical disc arthroplasty; cervical lordosis; cervical spondylotic radiculopathy.