Chen Jyi-Feng, Lee Shih-Tseng, Wu Chieh-Tsai
Department of Neurosurgery, Neurospinal Section, Chang Gung University, Medical College and Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC.
J Spinal Disord Tech. 2010 Jul;23(5):321-7. doi: 10.1097/BSD.0b013e3181b15bc8.
Between January 2002 and December 2005, a prospective study was performed with 14 patients. The patients had cervical diseases and received more than 1 segment anterior cervical corpectomies.
We investigated the effectiveness of the hollow cylindrical polymethyl methacrylate (PMMA) strut with the autograft for fusion and reconstruction of the cervical spine after multiplelevel cervical corpectomy.
We usually used the titanium mesh cage to reconstruct the cervical spine after cervical corpectomy. A significant number of poor outcomes were noted. Because the mesh cage is very hard, it sinks into the vertebral body without the cortex. It is also difficulty to assess the fusion status.
A total of 14 patients (age range: 31 to 76 y) underwent anterior cervical corpectomy after fusion and reconstruction with cylindrical PMMA struts. Each patient was reinforced with anterior cervical plate fixation. Follow-up radiographic evaluation was comprised of plain lateral dynamic radiographs and computerized tomography (CT) scans. We evaluated the patients for cervical lordosis and vertebral body height on the basis of plain radiographs. The fusion status was evaluated with CT scans. Neurologic status was assessed preoperative and postoperatively using the Nurick's grading system.
: The mean follow-up was 48.2 months (range: 28 to 70 mo). All patients showed spinal stability at 6 months follow-up on the basis of plain lateral dynamic radiograph results. Thirteen patients showed neurologic improvement with complete bony fusion in the 24-month reconstructed CT scans. There were no complications related to the hollow cylindrical PMMA strut. One patient had loosened screws and required a second operation.
The cylindrical PMMA strut provides solid fusion and increased cervical lordosis and vertebral body height. There are few complications associated with the use of this strut, and neurologic recovery is satisfactory. The hollow cylindrical PMMA strut, combined with an anterior cervical plate, is a very successful surgical construct in these patients after long-segmental cervical corpectomy.
2002年1月至2005年12月期间，对14例患者进行了一项前瞻性研究。这些患者患有颈椎疾病，接受了超过1节段的颈椎前路椎体次全切除术。
我们研究了中空圆柱形聚甲基丙烯酸甲酯（PMMA）支撑物联合自体骨移植在多节段颈椎椎体次全切除术后颈椎融合与重建中的有效性。
我们通常使用钛网笼在颈椎椎体次全切除术后重建颈椎。但发现有相当数量的预后不佳情况。因为网笼非常硬，它会沉入没有皮质的椎体中。而且评估融合状态也很困难。
共有14例患者（年龄范围：31至76岁）在使用圆柱形PMMA支撑物进行融合与重建后接受了颈椎前路椎体次全切除术。每位患者均采用颈椎前路钢板固定加强。随访影像学评估包括普通侧位动态X线片和计算机断层扫描（CT）。我们根据普通X线片评估患者的颈椎前凸和椎体高度。通过CT扫描评估融合状态。术前和术后使用Nurick分级系统评估神经功能状态。
平均随访48.2个月（范围：28至70个月）。根据普通侧位动态X线片结果，所有患者在6个月随访时均显示脊柱稳定。在24个月的重建CT扫描中，13例患者神经功能改善且实现了完全骨融合。没有与中空圆柱形PMMA支撑物相关的并发症。1例患者螺钉松动，需要再次手术。
圆柱形PMMA支撑物提供了牢固的融合，增加了颈椎前凸和椎体高度。使用该支撑物相关的并发症很少，神经功能恢复令人满意。中空圆柱形PMMA支撑物联合颈椎前路钢板，对于这些长节段颈椎椎体次全切除术后的患者来说是一种非常成功的手术构建方式。
