Kim Kyongsong, Isu Toyohiko, Sugawara Atsushi, Morimoto Daijiro, Matsumoto Ryoji, Isobe Masanori, Mishina Masahiro, Kobayashi Shiro, Teramoto Akira
Department of Neurosurgery, Chiba Hokuso Hospital, Nippon Medical School, Inzai, Chiba, Japan.
Neurol Med Chir (Tokyo). 2011;51(3):208-13. doi: 10.2176/nmc.51.208.
Detailed changes involved in the worsening of the fused segment angle were assessed after application of the Williams-Isu method using autologous bone grafts from cervical vertebral bodies in 30 patients with cervical disease treated by single-level anterior fusion. The mean follow-up duration was 25.4 months. The fused segment angle was measured on serial radiographs. Whole cervical spine alignment changed from 12.8° to 9.9°. The alignment of the fused segment worsened by mean 3.3°. To elucidate the characteristics of worsening of the fused segment, the 30 patients were divided into 2 groups: Group I (n = 20) without and Group II (n = 10) with postoperative worsening of the fused segment. The loss in the fused segment angle was significantly greater in Group II (8.0°) than Group I (0.9°). Preoperative range of motion and disc height were significantly greater in Group II than Group I. Worsening of the fused segment angle occurred within 1 month in Group I, whereas stabilization was observed after 3 months in Group II. Graft subsidence was primarily posterior and inferior. Our results indicate that the preoperative range of motion and disc height of the fused segment must be considered to prevent worsening in that segment after anterior fusion. Such detailed information is useful for the selection and postoperative monitoring of patients eligible for treatment by the Williams-Isu method.
在30例接受单节段前路融合术治疗的颈椎病患者中，应用Williams-Isu法取自体颈椎椎体骨移植后，评估融合节段角度恶化所涉及的详细变化。平均随访时间为25.4个月。在连续X线片上测量融合节段角度。整个颈椎排列从12.8°变为9.9°。融合节段的排列平均恶化3.3°。为了阐明融合节段恶化的特征，将30例患者分为2组：I组（n = 20）无融合节段术后恶化，II组（n = 10）有融合节段术后恶化。II组（8.0°）融合节段角度的丢失明显大于I组（0.9°）。II组术前活动范围和椎间盘高度明显大于I组。I组融合节段角度恶化发生在1个月内，而II组在3个月后观察到稳定。植骨沉降主要在后方和下方。我们的结果表明，必须考虑融合节段术前的活动范围和椎间盘高度，以防止前路融合术后该节段恶化。这些详细信息对于选择Williams-Isu法治疗的患者以及术后监测很有用。
