Ramzi Najib, Ribeiro-Vaz Geraldo, Fomekong Edward, Lecouvet Frédéric E, Raftopoulos Christian
Department of Neurosurgery, Cliniques Universitaires St-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, 1200 Brussels, Belgium.
Acta Neurochir (Wien). 2008 Dec;150(12):1249-56; discussion 1256. doi: 10.1007/s00701-008-0140-1. Epub 2008 Nov 11.
To determine the long term efficacy of coral grafts in anterior cervical discectomy and fusion.
In this prospective longitudinal study, All patients presenting with myelopathy and/or radiculopathy due to discal hernia or cervical spondylosis underwent anterior cervical microdiscectomy, arthrodesis with coral, and stabilization with anterior cervical locking plates. Clinical and radiological post-operative evaluations were performed at 2 days, 3, 6, and 12 months, and then yearly. The visual analogue scale was used for the evaluation of pain. Fusion was defined as the absence of motion on dynamic imaging combined with the disappearance of radio-lucent lines around the graft. The mean follow-up period was 44 months. In 83.3%, 91.2% and 93.7% of patients there was a satisfactory outcome for neck pain, arm pain, and motor deficit, respectively. The overall complication rate was 17.5%, all of which were transient. Additional surgery was required in nine cases. The occurrence of complications is correlated with less satisfactory outcomes for both neck and arm pain. While 95.5% of patients expressed overall satisfaction with their surgery, 70.5% stated that they had returned to their previous activities. The fusion rate was 45%; which was not correlated with clinical outcome and more likely in patients with of cervical spondylosis and one-level arthrodesis.
Despite satisfactory clinical results and a long follow-up period, coral implants yield low fusion rates, particularly in patients with discal hernia of two-level arthrodesis. The use of coral grafts cannot be recommended when fusion is one of the post-operative endpoints.
确定珊瑚移植物在前路颈椎间盘切除融合术中的长期疗效。
在这项前瞻性纵向研究中，所有因椎间盘突出或颈椎病导致脊髓病和/或神经根病的患者均接受了前路颈椎显微椎间盘切除术、珊瑚植骨融合术以及前路颈椎锁定钢板固定术。术后分别在2天、3个月、6个月和12个月进行临床和影像学评估，之后每年评估一次。采用视觉模拟量表评估疼痛。融合定义为动态成像显示无活动且移植物周围透亮线消失。平均随访期为44个月。分别有83.3%、91.2%和93.7%的患者颈部疼痛、手臂疼痛和运动功能障碍的治疗效果令人满意。总体并发症发生率为17.5%，均为暂时性的。9例患者需要再次手术。并发症的发生与颈部和手臂疼痛的治疗效果欠佳相关。虽然95.5%的患者对手术总体满意，但70.5%的患者表示已恢复到术前活动状态。融合率为45%；与临床结果无关，在颈椎病和单节段融合的患者中更易出现。
尽管临床结果令人满意且随访期较长，但珊瑚植入物的融合率较低，尤其是在双节段融合的椎间盘突出患者中。当融合是术后终点之一时，不建议使用珊瑚移植物。
