Bärlocher Christian B, Barth Alain, Krauss Joachim K, Binggeli Ralph, Seiler Rolf W
Department of Neurosurgery, Inselspital, University of Berne, Switzerland.
Neurosurg Focus. 2002 Jan 15;12(1):E4. doi: 10.3171/foc.2002.12.1.5.
The need for interbody fusion or stabilization after anterior cervical microdiscectomy is still debated. The objectives of this prospective randomized study were 1) to examine whether combined interbody fusion and stabilization is more beneficial than microdiscectomy only (MDO) and 2) if fusion is found to be more beneficial than MDO, to determine which is the best method of fusion by comparing the results achieved using autologous bone graft (ABG), polymethylmethacrylate (PMMA) interposition, and threaded titanium cage (TTC).
A total of 125 patients with a single-level cervical disc disease were included in this prospective study. All patients were randomized and assigned to one of the four following groups: Group 1 (33 patients), MDO; Group 2 (30 patients), microdiscectomy followed by ABG; Group 3 (26 patients), microdiscectomy followed by injection of PMMA; and Group 4 (36 patients), microdiscectomy followed by placement of a TTC. Clinical outcome according to Odom criteria was summarized as 1) excellent and good or 2) satisfactory and poor. One-year follow-up examination was performed in 123 patients. Patients in the TTC group experienced a significantly better outcome 6 months after surgery (92% excellent and good results) compared with those in the MDO and ABG groups (72.7 and 66.6% excellent and good results, respectively). Twelve months after surgery there was still a significant difference in outcomes between the TTC group (94.4% excellent and good results) and the MDO group (75.5% excellent and good results). Outcome in patients treated with PMMA was comparable with that in those treated with TCC after 6 (91.6%) and 12 months (87.5%), but no segmental fusion was achieved. Differences compared with MDO and ABG were, however, not significant, which may be related to the smaller number of patients in the PMMA group.
Interbody cage-assisted fusion yields a significantly better short- and intermediate-term outcome than MDO in terms of return to work, radicular pain, Odom criteria, and earlier fusion. In addition, the advantages of interbody cages over ABG fusion included better results in terms of return to work, Odom criteria, and earlier fusion after 6 months. These results suggest that interbody cage-assisted fusion is a promising therapeutic option in patients with single-level disc disease. Polymethylmethacrylate seems to be a good alternative to interbody cage fusion but is hindered by the absence of immediate fusion.
颈椎前路显微椎间盘切除术后是否需要椎间融合或稳定仍存在争议。这项前瞻性随机研究的目的是：1）研究椎间融合与稳定联合应用是否比单纯显微椎间盘切除术（MDO）更有益；2）如果发现融合比MDO更有益，通过比较自体骨移植（ABG）、聚甲基丙烯酸甲酯（PMMA）置入和带螺纹钛笼（TTC）的结果，确定哪种是最佳融合方法。
本前瞻性研究共纳入125例单节段颈椎间盘疾病患者。所有患者随机分为以下四组之一：第1组（33例），MDO；第2组（30例），显微椎间盘切除术后行ABG；第3组（26例），显微椎间盘切除术后注射PMMA；第4组（36例），显微椎间盘切除术后置入TTC。根据奥多姆标准将临床结果总结为：1）优和良或2）满意和差。123例患者进行了为期一年的随访检查。与MDO组（优和良的结果分别为72.7%）和ABG组（优和良的结果分别为66.6%）相比，TTC组患者术后6个月的结果明显更好（优和良的结果为92%）。术后12个月，TTC组（优和良的结果为94.4%）与MDO组（优和良的结果为75.5%）的结果仍存在显著差异。PMMA治疗患者术后6个月（91.6%）和12个月（87.5%）的结果与TCC治疗患者相当，但未实现节段融合。然而，与MDO和ABG相比的差异不显著，这可能与PMMA组患者数量较少有关。
在恢复工作、神经根性疼痛、奥多姆标准和早期融合方面，椎间融合器辅助融合在短期和中期的效果明显优于MDO。此外，椎间融合器相对于ABG融合的优势包括在恢复工作、奥多姆标准和6个月后早期融合方面有更好的结果。这些结果表明，椎间融合器辅助融合是单节段椎间盘疾病患者一种有前景的治疗选择。聚甲基丙烯酸甲酯似乎是椎间融合器融合的一个好替代方案，但因缺乏即刻融合而受到阻碍。
