Epstein N E
Department of Surgery (Neurosurgery), North Shore University Hospital, Manhasset, New York, USA.
J Spinal Disord. 2000 Feb;13(1):1-8. doi: 10.1097/00002517-200002000-00001.
Between 1989 and 1996, fusion, pseudarthrosis, repeated operation rates, and outcomes were studied in 178 patients undergoing one- to four-level (average, 2.2 levels) anterior cervical diskectomy and fusion (ADF) without plating. Dynamic radiographs taken 3 and 6 months after operation showed fusion or pseudarthrosis without motion in 99% of patients after one-level ADF (78 patients), in 90% after two-level ADF (84 patients), and in 100% after three-level ADF (12 patients) and four-level ADF (4 patients). Pseudarthrosis with motion was noted in 1% after one-level ADF and in 10% after two-level ADF (statistically significant with a lower pseudarthrosis rate in the 1-level; by Fisher's exact test, p = 0.0351). Three patients required secondary posterior wiring and fusion. Good or excellent outcomes (by Odom's criteria) were achieved in 96% of patients within an average of 82 months. Although fusion rates for one-level ADF without plates appear adequate, high pseudarthrosis rates after two-level ADF warrant that plating be considered.
1989年至1996年期间，对178例行单节段至四节段（平均2.2节段）前路颈椎间盘切除融合术（ADF）且未使用钢板固定的患者的融合情况、假关节形成情况、再次手术率及治疗结果进行了研究。术后3个月和6个月拍摄的动态X线片显示，单节段ADF（78例患者）术后99%的患者出现融合或假关节形成且无活动，双节段ADF（84例患者）术后90%的患者如此，三节段ADF（12例患者）和四节段ADF（4例患者）术后100%的患者如此。单节段ADF术后1%的患者出现有活动的假关节形成，双节段ADF术后10%的患者出现这种情况（单节段假关节形成率较低，具有统计学意义；通过Fisher精确检验，p = 0.0351）。3例患者需要二期后路钢丝固定及融合术。平均82个月内，96%的患者获得了良好或优秀的治疗结果（根据奥多姆标准）。尽管未使用钢板的单节段ADF融合率似乎足够，但双节段ADF术后较高的假关节形成率表明应考虑使用钢板固定。
