Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, 80, Guro-dong, Guro-gu, Seoul, 152-703, South Korea.
Acta Neurochir (Wien). 2011 Mar;153(3):559-65. doi: 10.1007/s00701-010-0879-z. Epub 2010 Dec 4.
Anterior cervical discectomy and fusion (ACDF) using stand-alone cages is an effective method of treating degenerative disease. However, stand-alone cages are reported to have a relatively high incidence of implant subsidence with secondary kyphotic deformity particularly after multilevel ACDF. The purpose of our article was to investigate clinical and radiological outcomes after ACDF using stand-alone cages, at two contiguous levels, with a particular focus on changes in regional alignment and the correlation between alignment of the operated cervical levels and the entire cervical spine.
Twenty-seven patients with 54 levels and a mean age of 50.8 years were enrolled between January 2005 and August 2006. They underwent ACDF using polyetheretherketone cages packed with demineralized bone matrix without plate fixation at two contiguous levels. Mean follow-up period was 25.5 months (range, 13-60). Clinical outcome was evaluated using two Visual Analog Scales and the Neck Disability Index (NDI). We assessed fusion, regional alignment (RA) of the operated levels and cervical global alignment (GA) preoperatively in the immediate 1-week postoperative period and at the final follow-up. An interspinous distance ≥2 mm was used as an indicator of pseudoarthrosis at each level.
All patients showed improvements in clinical outcome, with 96% of patients showing mild NDI scores (<14). Radiological solid fusion was obtained at 48 of 54 levels (88.9%) and in 21 of 27 patients (77.8%). Lower cervical levels were significantly more vulnerable to pseudoarthrosis (100%). Fusion rate had no significant correlation with outcome (p > 0.05). RA of the operated levels was improved at the final follow-up compared with preoperatively in 76% of patients, although it had decreased compared with the immediate postoperative period due to subsidence in 84% of patients. In total, 80.8% of patients showed improvements in GA. Furthermore, improvements in RA showed a significant positive correlation with those in GA (p = 0.001), although improvement in RA and GA did not correlate significantly with clinical outcome (p > 0.05).
Though some degree of subsidence occurred in most cases, RA had improved at the last follow-up compared with preoperatively, which contributed to the significant improvement in GA. However, improvement of RA and GA was not correlated with outcomes.
颈椎前路椎体间融合术（ACDF）使用独立的椎间融合器是治疗退行性疾病的有效方法。然而，据报道，独立的椎间融合器在术后发生植入物下沉和继发性后凸畸形的风险相对较高，尤其是在多节段 ACDF 后。我们的研究目的是调查颈椎前路融合术（ACDF）使用独立椎间融合器治疗相邻两节段退行性疾病的临床和影像学结果，重点关注区域排列的变化以及手术颈椎节段与整个颈椎的排列之间的相关性。
2005 年 1 月至 2006 年 8 月，共纳入 27 例患者（54 个节段），平均年龄为 50.8 岁。所有患者均采用聚醚醚酮（PEEK）椎间融合器（内填充脱钙骨基质）进行颈椎前路融合术，不使用钢板固定相邻两节段。平均随访时间为 25.5 个月（13-60 个月）。临床结果采用视觉模拟评分法（VAS）和颈痛残疾指数（NDI）进行评估。我们在术前即刻、术后 1 周及末次随访时评估融合情况、手术节段的区域排列（RA）和颈椎总体排列（GA）。每个节段的棘突间距离≥2mm 被认为是假关节形成的指标。
所有患者的临床结果均得到改善，96%的患者的 NDI 评分为轻度（<14）。48 个节段（88.9%）和 21 例患者（77.8%）获得影像学融合。下颈椎更容易发生假关节（100%）。融合率与结果无显著相关性（p>0.05）。术后 76%的患者手术节段的 RA 较术前得到改善，但由于 84%的患者发生植入物下沉，术后 RA 较术后即刻时降低。总的来说，80.8%的患者的 GA 得到改善。此外，RA 的改善与 GA 的改善呈显著正相关（p=0.001），但 RA 和 GA 的改善与临床结果无显著相关性（p>0.05）。
尽管大多数病例都发生了一定程度的下沉，但与术前相比，RA 在末次随访时得到了改善，这有助于 GA 的显著改善。然而，RA 和 GA 的改善与结果无关。
