Joung Young Il, Oh Seong Hoon, Ko Yong, Yi Hyeong Joong, Lee Seung Ku
Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
J Korean Neurosurg Soc. 2007 Nov;42(5):367-70. doi: 10.3340/jkns.2007.42.5.367. Epub 2007 Nov 20.
There are numerous reports on the primary stabilizing effects of the different cervical cages for cervical radiculopathy. But, little is known about the subsidence which may be clinical problem postoperatively. The goal of this study is to evaluate subsidence of cage and investigate the correlation between radiologic subsidence and clinical outcome.
To assess possible subsidence, the authors investigated clinical and radiological results of the one-hundred patients who underwent anterior cervical fusion by using AMSLUtrade mark cage during the period between January 2003 and June 2005. Preoperative and postoperative lateral radiographs were measured for height of intervertebral disc space where cages were placed. Intervertebral disc space was measured by dividing the sum of anterior, posterior, and midpoint interbody distance by 3. Follow-up time was 6 to 12 months. Subsidence was defined as any change in at least one of our parameters of at least 3 mm.
Subsidence was found in 22 patients (22%). The mean value of subsidence was 2.21 mm, and mean subsidence rate was 22%. There were no cases of the clinical status deterioration during the follow-up period. No posterior or anterior migration was observed.
The phenomenon of subsidence is seen in substantial number of patients. Nevertheless, clinical and radiological results of the surgery were favorable. An excessive subsidence may result in hardware failure. Endplate preservation may enables us to control subsidence and reduce the number of complications.
关于不同颈椎椎间融合器对神经根型颈椎病的初始稳定作用已有大量报道。但是,对于术后可能出现的下沉这一临床问题却知之甚少。本研究的目的是评估椎间融合器的下沉情况,并探讨影像学下沉与临床疗效之间的相关性。
为评估可能出现的下沉情况,作者调查了2003年1月至2005年6月期间接受前路颈椎融合术并使用AMSLU商标椎间融合器的100例患者的临床和影像学结果。测量术前和术后放置椎间融合器处椎间隙的高度。椎间隙高度通过将椎体前缘、后缘及椎体间中点距离之和除以3来测量。随访时间为6至12个月。下沉定义为至少一个参数出现至少3毫米的变化。
22例患者(22%)出现下沉。下沉的平均值为2.21毫米,平均下沉率为22%。随访期间无临床症状恶化病例。未观察到后方或前方移位。
大量患者出现下沉现象。然而,手术的临床和影像学结果良好。过度下沉可能导致内固定失败。保留终板可能有助于控制下沉并减少并发症的发生。