Auguste Kurtis I, Chin Cynthia, Acosta Frank L, Ames Christopher P
Department of Neurological Surgery, Brain Tumor Research Center, University of California, San Francisco School of Medicine, San Francisco, California 94143-0112, USA.
J Neurosurg Spine. 2006 Apr;4(4):285-91. doi: 10.3171/spi.2006.4.4.285.
Expandable cylindrical cages (ECCs) have been utilized successfully to reconstruct the thoracic and lumbar spine. Their advantages include ease of insertion, reduced endplate trauma, direct application/maintenance of interbody distraction force, and one-step kyphosis correction. The authors present their experience with ECCs in the reconstruction of the cervical spine in patients with various pathological conditions.
Data obtained in 22 patients were reviewed retrospectively. A standard anterior cervical corpectomy was performed in all cases. Local vertebral body bone was harvested for use as graft material. Patients underwent pre- and postoperative assessment involving the visual analog scale (VAS), Nurick grading system for determining myelopathy disability, and radiographic studies to determine cervical kyphosis/lordosis and cage subsidence. Fusion was defined as the absence of motion on flexion-extension x-ray films. Sixteen patients presented with spondylotic myelopathy, two with osteomyelitis, two with fracture, one with tumor metastasis, and one with severe stenosis. Fourteen patients underwent supplemental posterior spinal fusion, seven underwent single-level corpectomy, and 15 patients underwent multilevel corpectomy. No perioperative complications occurred. The mean follow-up period was 22 months. In 11 patients with preexisting kyphosis (mean deformity +19 degrees), the mean correction was 22 degrees. There was no statistically significant difference in subsidence between single- and multilevel corpectomy or between 360 degrees fusion and anterior fusion alone. The VAS scores improved by 35%, and the Nurick grade improved by 31%. The fusion rate was 100%.
The preliminary results support the use of ECCs in the cervical spine in the treatment of patients with various disease processes. No significant subsidence was noted, and pain and functional scores improved in all cases. Expandable cylindrical cages appear to be well suited for cervical reconstruction and for correcting sagittal malalignment.
可扩张圆柱形椎间融合器（ECCs）已成功用于胸腰椎重建。其优点包括易于植入、减少终板损伤、直接施加/维持椎间撑开力以及一步法矫正后凸畸形。作者介绍了他们在各种病理状况患者的颈椎重建中使用ECCs的经验。
对22例患者的数据进行回顾性分析。所有病例均行标准的前路颈椎椎体次全切除术。取局部椎体骨作为植骨材料。患者术前和术后接受视觉模拟评分（VAS）、用于确定脊髓病残疾程度的努里克分级系统评估以及影像学检查以确定颈椎后凸/前凸和椎间融合器下沉情况。融合定义为屈伸位X线片上无活动。16例患者患有脊髓型颈椎病，2例患有骨髓炎，2例患有骨折，1例患有肿瘤转移，1例患有严重狭窄。14例患者接受了辅助后路脊柱融合术，7例接受了单节段椎体次全切除术，15例接受了多节段椎体次全切除术。未发生围手术期并发症。平均随访期为22个月。在11例术前存在后凸畸形（平均畸形+19度）的患者中，平均矫正度为22度。单节段和多节段椎体次全切除术之间或360度融合与单纯前路融合之间的下沉情况无统计学显著差异。VAS评分提高了35%，努里克分级提高了31%。融合率为100%。
初步结果支持在各种疾病进程的患者颈椎治疗中使用ECCs。未观察到明显下沉，所有病例的疼痛和功能评分均有所改善。可扩张圆柱形椎间融合器似乎非常适合颈椎重建和矫正矢状面畸形。
