Rohe Simone M, Engelhardt M, Harders A, Schmieder K
Ruhr-University, Department of Neurosurgery, Bochum, Germany.
Cent Eur Neurosurg. 2009 Nov;70(4):180-6. doi: 10.1055/s-0029-1220940. Epub 2009 Aug 31.
The purpose of this study was to prospectively evaluate long-term results after anterior cervical discectomy and titanium cage fusion (ACDF) and titanium cage fusion. Special focus was on the adjacent levels.
54 patients (age: 48+/-10 years; one level operation in 44 patients and two level operation in 10 patients) entered the study. Re-evaluation consisted of a clinical out patient investigation and was possible in 33 patients. VAS, PROLO and Oswestry scores were used. Lateral radiographs were taken and changes in the operated and adjacent segments were measured and compared to radiographs directly after surgery. Clinical patient data was compared with the data prior to surgery.
The mean follow-up time of the 33 patients was 7.26 +/- 0.22 years. One patient needed re-surgery of the cervical spine above the fused segment. PROLO results showed a significant improvement (PROLO F 1.52+/-0.67 to 3.79+/-1.17 p<0.01; PROLO E 1.52+/-0.5 to 3.55+/-1.42 p<0.01). Mean VAS at the time of investigation was 3.2+/-2.5. Oswestry score was 16.4+/-9.5. The alignment of the whole cervical spine was stable lordotic (Katsuura 10.9+/-9.0 degrees to 11.5+/-7.8 degrees ; p=0.76). Total segmental height had reduced from 36.6+/-4.6 mm to 34.6+/-3.9 mm (p=0.04). No significant reduction of disc space height of adjacent levels was detectable (superior: 5.8+/-1.6 mm to 5.2+/-1.6 mm; inferior: 6.0+/-1.7 mm to 5.3+/-1.9 mm). One adjacent superior level showed spontaneous fusion. Ventral and dorsal osteophytes in the superior and inferior adjacent levels increased in number and increased significantly in degree. Patients with bi-segmental fusion (n=7) showed similar results.
ACDF with titanium cages has good clinical long-term results. A significant progression of degenerative changes can be observed on radiographs without clinical consequences for the patients. A comparison with patients without surgery and conservative therapy is needed to allow a better interpretation of the radiological results.
本研究的目的是前瞻性评估颈椎前路椎间盘切除钛笼融合术（ACDF）后的长期疗效，特别关注相邻节段。
54例患者（年龄：48±10岁；44例患者接受单节段手术，10例患者接受双节段手术）进入研究。重新评估包括临床门诊调查，33例患者可进行此项评估。使用视觉模拟评分法（VAS）、PROLO评分和奥斯维斯特里功能障碍指数（Oswestry）评分。拍摄颈椎侧位X线片，测量手术节段和相邻节段的变化，并与术后即刻的X线片进行比较。将患者的临床数据与术前数据进行比较。
33例患者的平均随访时间为7.26±0.22年。1例患者需要对融合节段上方的颈椎进行再次手术。PROLO评分结果显示有显著改善（PROLO F从1.52±0.67提高到3.79±1.17，p<0.01；PROLO E从1.52±0.5提高到3.55±1.42，p<0.01）。调查时的平均VAS评分为3.2±2.5。Oswestry评分为16.4±9.5。整个颈椎的曲度保持稳定前凸（Katsuura角从10.9±9.0度变为11.5±7.8度；p = 0.76）。节段总高度从36.6±4.6mm降至34.6±3.9mm（p = 0.04）。未检测到相邻节段椎间盘间隙高度有显著降低（上方：从5.8±1.6mm降至5.2±1.6mm；下方：从6.0±1.7mm降至5.3±1.9mm）。一个相邻的上位节段出现自发融合。上下相邻节段的腹侧和背侧骨赘数量增加，程度显著加重。双节段融合患者（n = 7）的结果相似。
钛笼ACDF具有良好的临床长期疗效。X线片上可观察到退变改变有显著进展，但对患者无临床影响。需要与未手术及保守治疗的患者进行比较，以便更好地解读影像学结果。
