Lin Hung-Lin, Cho Der-Yang, Liu Yu-Fang, Lee Wen-Yuan, Lee Han-Chung, Chen Chun-Chung
Departments of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
Br J Neurosurg. 2008 Dec;22(6):758-63. doi: 10.1080/02688690802379134.
Postoperative limitation of cervical movement and adjacent disc degeneration are major causes of postoperative neck pain after anterior cervical discectomy and interbody fusion (ACDF). We present a retrospective study of dynamic radiographic change following ACDF with cages. We performed ACDF in 50 patients with cervical degenerative diseases, divided into three groups based on the level of interbody fusion (Group A: one-level; Group B: two-level; Group C: three-level). Preoperative and postoperative flexion-extension X-rays were acquired and cervical range of motion (ROM), lordosis, fusion rate, cage subsidence rate, postoperative neck pain as evaluated by visual analogue scale (VAS) and upper adjacent level segmental movement were evaluated. The average following time was 14.6 months. The mean change in lordotic curve was -2.31 +/- 9.53 degrees for Group A, 5.60 +/- 6.96 degrees for Group B, and 3.23 +/- 7.50 degrees for Group C (p value = 0.03). The mean change in flexion angle was -5.46 +/- 8.69 degrees for Group A, -10.2 +/- 7.38 degrees for Group B, and -13.86 +/- 10.33 degrees for Group C (p value = 0.039). The mean change in total cervical ROM was -3.85 +/- 18.74 degrees for Group A, -12.73 +/- 10.31 degrees for Group B, and -16.95 +/- 10.57 degrees for Group C (p value = 0.02). Follow-up cervical MRI for patients with persistent neck pain showed no evidence of adjacent level degeneration. There were no significant differences between the three groups with respect to postoperative change in cervical extension angle, upper adjacent level segmental movement, neck pain VAS, fusion rate or cage subsidence rate. The further decrease in total cervical ROM and flexion movement after multi-level ACDF was observed. However, a more long-term follow-up was needed to assess the actual aetiologies of upper adjacent level degeneration.
颈椎前路椎间盘切除椎间融合术（ACDF）后颈部活动受限及相邻椎间盘退变是术后颈部疼痛的主要原因。我们对采用椎间融合器的ACDF术后动态影像学变化进行了一项回顾性研究。我们对50例颈椎退行性疾病患者实施了ACDF，根据椎间融合节段分为三组（A组：单节段；B组：双节段；C组：三节段）。采集术前和术后屈伸位X线片，评估颈椎活动度（ROM）、前凸、融合率、椎间融合器下沉率、采用视觉模拟评分法（VAS）评估的术后颈部疼痛以及上位相邻节段的节段性活动。平均随访时间为14.6个月。A组前凸曲线平均变化为-2.31±9.53度，B组为5.60±6.96度，C组为3.23±7.50度（p值=0.03）。A组屈曲角度平均变化为-5.46±8.69度，B组为-10.2±7.38度，C组为-13.86±10.33度（p值=0.039）。A组颈椎总ROM平均变化为-3.85±18.74度，B组为-12.73±10.31度，C组为-16.95±10.57度（p值=0.02）。对持续性颈部疼痛患者进行的随访颈椎MRI未显示相邻节段退变迹象。三组在术后颈椎后伸角度变化、上位相邻节段节段性活动、颈部疼痛VAS、融合率或椎间融合器下沉率方面无显著差异。观察到多节段ACDF后颈椎总ROM和屈曲活动进一步下降。然而，需要更长时间的随访来评估上位相邻节段退变的实际病因。
