Chagas Haroldo, Domingues Flavio, Aversa Antonio, Vidal Fonseca Ana Luiza, de Souza Jorge Marcondes
Division of Neurosurgery, University Hospital-Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Surg Neurol. 2005;64 Suppl 1:S1:30-5; discussion S1:35-6. doi: 10.1016/j.surneu.2005.02.016.
Fifty-one patients with cervical spondylotic myelopathy (CSM) treated by anterior cervical corpectomy with fusion (ACWF) at our institution were included in a study during a period of 10 years to evaluate neurological, anatomical, and functional outcomes including satisfaction levels.
We have completed a prospective evaluation of 39 patients with spondylotic myelopathy submitted to ACWF during the period of 1989-2000. The data were analyzed for age, duration of symptoms, severity of preoperative neurological deficit, and single-level or multilevel compressive status looking for possible association with prognostic surrogate data and clinical outcome that were evaluated with the Nurick score and a survey of level of satisfaction.
Of the 51 patients, 39 fullfilled the intended follow-up being 28 men (71.8%) and 11 women (28.2%). The average age was 63.5 years. Duration of symptoms ranged from 1 to 240 months (mean, 38.1 months). The mean preoperative Nurick scale score was 2.97; the mean postoperative score was 2.1. The most frequently involved vertebral body was C5 (71.7%). The follow-up period was longer than 18 months for all patients. Postoperative nonneurological complications occurred in 8 patients (15.6%). The mortality rate was 1.9% (n = 1). Postoperative results showed improvement in 25 patients (64.1%), no change in 13 (33.3%), and worsening in 1 (2.6%). The correlation coefficient of preoperative and postoperative Nurick scores was 0.733 (R(2) = 0.53). Of the 39 patients, 31 answered the questionnaire for quality of life-19 (61.2%) were very satisfied, 6 were satisfied (19.35%), and 6 were not satisfied (19.35%).
Most patients (80.6%) were very satisfied or satisfied with the outcome and would decide again for the surgery (87%) if the results were previously known. Anterior cervical corpectomy with fusion was a reliable and rewarding procedure for CSM, with functional improvement in most patients. Excellent long-term outcome results in cervical fusion can be achieved without the use of hardware instrumentation.
在10年期间，我们机构纳入了51例行颈椎前路椎体次全切除融合术（ACWF）治疗的脊髓型颈椎病（CSM）患者，以评估神经、解剖和功能结局，包括满意度。
我们对1989年至2000年期间接受ACWF治疗的39例脊髓型颈椎病患者进行了前瞻性评估。分析了患者的年龄、症状持续时间、术前神经功能缺损严重程度以及单节段或多节段受压情况，以寻找与预后替代数据和临床结局的可能关联，临床结局通过Nurick评分和满意度调查进行评估。
51例患者中，39例完成了预期随访，其中男性28例（71.8%），女性11例（28.2%）。平均年龄为63.5岁。症状持续时间为1至240个月（平均38.1个月）。术前Nurick量表平均评分为2.97；术后平均评分为2.1。最常受累椎体为C5（71.7%）。所有患者随访期均超过18个月。8例患者（15.6%）发生术后非神经并发症。死亡率为1.9%（n = 1）。术后结果显示好转25例（64.1%），无变化13例（33.3%），恶化1例（2.6%）。术前和术后Nurick评分的相关系数为0.733（R² = 0.53）。39例患者中，31例回答了生活质量问卷，其中61.2%的患者非常满意，6例满意（19.35%），6例不满意（19.35%）。
大多数患者（80.6%）对结局非常满意或满意，并且如果事先知道结果，87%的患者会再次选择该手术。颈椎前路椎体次全切除融合术是治疗CSM的可靠且有益的手术，大多数患者功能得到改善。不使用内固定器械也可实现颈椎融合的优异长期结局。
