Safety and early clinical efficacy of daytime anterior cervical discectomy and fusion(ACDF) in the treatment of cervical degenerative diseases

English Keywords:Daytime surgery  Anterior cervical discectomy and fusion  Cervical degenerative diseases  Safety  Early clinical efficacy

English Abstract:

  【Abstract】 Objectives: To explore the safety and early efficacy of daytime management model of anterior cervical discectomy and fusion(ACDF) in the treatment of cervical degenerative diseases(CDD). Methods: A retrospective analysis was performed on 12 patients with CDD who underwent daytime ACDF between September 2022 and March 2023. There were 10 females and 2 males, and the patients aged 53.7±8.6 years (36-67 years). 8 out of the patients underwent single-segment surgery, and the other 4 underwent double-segment surgery. Visual analogue scale(VAS), neck disability index(NDI), Japanese Orthopedic Association(JOA) score, JOA score recovery rate(RR), operative time, intraoperative blood loss, postoperative drainage, 30-day readmission rate, patient satisfaction with medical care, and complication rate were used to assess surgical safety and early clinical outcomes. Cervical X-rays, CT, and MRI examinations were taken to assess the location of implant, nerve decompression condition, and cervical curvature. Results: All the 12 patients were successfully operated and followed up for 2.5±0.8 months(1-6 months). The postoperative pain symptoms and nerve function were significantly improved. The operative time was 71.3±20.5min, the intraoperative blood loss was 14.6±8.4mL, and the postoperative drainage volume was 8.8±7.3mL. VAS(2.1±0.9 points), NDI[(22.4±3.5)%], and JOA score(14.3±1.1 points) on discharge were significantly improved compared with the VAS(6.6±1.7 points), NDI[(66.3±4.7)%], and JOA score(8.3±1.3 points) before operation(P<0.05), and JOA score RR was 100%. One patient had mild dysphagia after operation(8.3%), and the symptom disappeared without any special treatment. During the follow-up period, there was no case of re-admission within 30d after discharge, but 1 patient developed incision hematoma on 6d after discharge, with no difficulty in breathing or swallowing. After specialist examination and evaluation, pressure bandaging was performed, and the patient self-healed 4 days later. Postoperative imaging examination showed that the position of the implant was ideal, the nerve decompression was sufficient, and the postoperative cervical physiological curvature(28.7°±2.0°) was significantly improved compared with that before operation(15.7°±4.6°) (P<0.05). Conclusions: Daytime ACDF is relatively satisfied in the safety and early efficacy, which can provide a new surgical mode option for suitable patients with CDD.