Lin Chung-Nan, Wu Yu-Chuan, Wang Nai-Phon, Howng Shen-Long
Departments of Neurosurgery, Kuang-Tien General Hospital, Dajia, Taichung Hsien, Taiwan.
Kaohsiung J Med Sci. 2003 May;19(5):208-16. doi: 10.1016/S1607-551X(09)70426-7.
This study evaluated the efficacy and safety of titanium cage implants in cervical reconstruction to treat cervical spondylosis. Surgical data covered a 4-year period from January 1999 to December 2002 and included 34 consecutive patients, 20 men and 14 women, with ages ranging from 27 to 84 years (mean, 57 years). Patients underwent anterior cervical microdiscectomy followed by interbody fusion with a titanium cage implant (rather than an autogenous iliac crest bone graft) at a single level ranging from C3 to C7. Twenty-one patients had a herniated intervertebral disc, nine had degenerative disc disease, and four had previous failed autograft fusion surgery that required revision. At clinical presentation, 26 patients had neck pain, 23 had radiculopathy, and nine had myelopathy. Diagnostic imaging studies included spinal dynamic roentgenography, computerized tomography, and magnetic resonance imaging. Lesions were located at C3-4 in seven cases, C4-5 in 14 cases, C5-6 in nine cases, and C6-7 in four cases. The follow-up period ranged from 7 to 48 months (mean, 26 months). Results revealed that the procedure was technically feasible. There were no intra- or postoperative complications. The most commonly used cage was 9 mm high. Imaging studies showed no cage instability, migration, or pseudarthrosis. Although mild subsidence (< 5 mm) was observed in three cases, these patients preserved adequate postoperative cervical lordosis and the subsidence did not preclude a good clinical result. The advantages of this procedure over a similar operation using traditional tricorticate bone graft are: no graft morbidity; shorter operation time (mean time saved, 35 minutes); reduced blood loss (average blood loss, 75 mL); and early postoperative ambulation (mean, 4.7 hospital days). Nearly all patients rapidly lost their neck pain (92%, 24/26) and radicular symptoms (87%, 20/23) after surgery. The recovery rate from myelopathy was 44% (4/9). Progressive bony shield formation over the anterior/posterior cortex (sentinel sign) indicated fusion in five cases.
本研究评估了钛笼植入物在颈椎重建治疗颈椎病中的疗效和安全性。手术数据涵盖了1999年1月至2002年12月的4年期间，包括34例连续患者，其中男性20例，女性14例，年龄在27至84岁之间（平均57岁）。患者接受了颈椎前路显微椎间盘切除术，随后在C3至C7的单个节段进行钛笼植入物椎间融合术（而非自体髂嵴骨移植）。21例患者患有椎间盘突出症，9例患有椎间盘退变疾病，4例曾接受过自体骨移植融合手术但失败，需要翻修。临床表现方面，26例患者有颈部疼痛，23例有神经根病，9例有脊髓病。诊断性影像学检查包括脊柱动态X线摄影、计算机断层扫描和磁共振成像。病变位于C3 - 4节段7例，C4 - 5节段14例，C5 - 6节段9例，C6 - 7节段4例。随访期为7至48个月（平均26个月）。结果显示该手术在技术上是可行的。术中及术后均无并发症。最常用的钛笼高度为9毫米。影像学检查未显示钛笼不稳定、移位或假关节形成。虽然3例患者观察到轻度下沉（<5毫米），但这些患者术后保留了足够的颈椎前凸，且下沉并未妨碍良好的临床结果。该手术相对于使用传统三皮质骨移植的类似手术的优势在于：无移植相关并发症；手术时间缩短（平均节省35分钟）；失血减少（平均失血量75毫升）；术后早期可下床活动（平均住院4.7天）。几乎所有患者术后颈部疼痛（92%，24/26）和神经根症状（87%，20/23）迅速缓解。脊髓病的恢复率为44%（4/9）。5例患者前/后皮质出现渐进性骨盾形成（哨兵征）提示融合。
