Riew K D, Hilibrand A S, Palumbo M A, Bohlman H H
Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
J Bone Joint Surg Am. 1999 Jul;81(7):950-7. doi: 10.2106/00004623-199907000-00007.
The purpose of this study was to evaluate the complications of anterior cervical corpectomy and arthrodesis in patients who had had a previous cervical laminectomy. The results of previous studies have suggested that these patients can be managed with anterior decompression and an arthrodesis with either plate fixation or immobilization in a halo vest. However, no studies that we are aware of have specifically focused on the complications of these types of procedures.
The records and radiographs of eighteen patients who had been managed with a one to four-level corpectomy with strut-grafting were retrospectively reviewed. The reviews were independently performed by the three of us who were not involved in the original operation. The interval between the laminectomy and the corpectomy ranged from one month to twenty-two years (mean, eight years).
Eleven of the eighteen patients sustained a total of sixteen complications during the follow-up period, which averaged 2.7 years (range, seven months to six years and four months), and nine of the eleven had graft-related complications. Five grafts extruded or collapsed, or both. There were four reoperations. Immobilization in a halo vest did not prevent extrusions, as three of the four extrusions occurred while the patient wore a halo vest. Four patients had a pseudarthrosis. In three patients, the kyphosis increased by 10 degrees or more from the immediate preoperative period to the most recent follow-up evaluation. Two patients had respiratory distress that necessitated reintubation, one patient had a small dural tear, and one had transient dysphagia.
Our data suggest that anterior cervical corpectomy without instrumentation in a patient who has had a previous laminectomy is associated with a great risk of graft-related complications despite the use of a halo vest. This previously unreported finding is relevant in that it contradicts the recommendation previously made by Zdeblick and the senior one of us, who advocated postoperative immobilization in a halo vest for these patients. Anterior cervical corpectomy should be performed with caution and knowledge of the potential complications in a patient who has had a previous laminectomy.
本研究的目的是评估既往接受过颈椎椎板切除术的患者行颈椎前路椎体次全切除及融合术的并发症。既往研究结果提示，这些患者可通过前路减压及融合术（采用钢板固定或头环背心固定）进行治疗。然而，据我们所知，尚无研究专门关注这类手术的并发症。
回顾性分析18例行1至4节段椎体次全切除并支撑植骨术患者的病历及影像学资料。由未参与原手术的三人独立进行回顾分析。椎板切除术与椎体次全切除术之间的间隔时间为1个月至22年（平均8年）。
18例患者中有11例在平均2.7年（范围7个月至6年4个月）的随访期内共出现16种并发症，其中11例中有9例出现与植骨相关的并发症。5块植骨出现移位或塌陷，或两者皆有。进行了4次再次手术。头环背心固定并不能防止植骨移位，4例移位中有3例发生在患者佩戴头环背心期间。4例患者出现假关节形成。3例患者的后凸畸形从术前即刻至最近一次随访评估增加了10度或更多。2例患者出现呼吸窘迫，需要再次插管，1例患者出现硬脊膜小撕裂，1例患者出现短暂吞咽困难。
我们的数据表明，既往接受过椎板切除术的患者行颈椎前路椎体次全切除且未使用内固定时，尽管使用了头环背心，仍有发生与植骨相关并发症的高风险。这一先前未报道的发现具有重要意义，因为它与Zdeblick及我们中的年长者之前的建议相矛盾，他们主张对这些患者术后采用头环背心固定。对于既往接受过椎板切除术的患者，行颈椎前路椎体次全切除术时应谨慎操作，并了解潜在并发症。
