Department of Spine Surgery, Changzheng Orthopedics Hospital, Second Military Medical University, Shanghai 200003, China.
Eur Spine J. 2012 Dec;21(12):2428-35. doi: 10.1007/s00586-012-2323-y. Epub 2012 May 29.
Anterior approach was extensively used in surgical treatment of multilevel cervical spondylotic myelopathy. Following anterior decompression, many different reconstructive techniques (multilevel ACDF, hybrid construct and long corpectomy) all had satisfied outcomes. However, there are few studies focusing on the comparison of these three reconstructed techniques. The aim of this retrospective study was to analyze the complications of these three different methods.
This study retrospectively reviewed the complications in 286 consecutive patients with multilevel CSM who underwent anterior cervical surgery from 2005 to 2010. This case series had 166 men and 120 women whose mean age at surgery was 53.8 years (range from 33 to 74 years). Radiographic evaluation was taken the day after surgery, and the flexion-extension X-rays were added 3, 12 and 24 months postoperatively to evaluate the fusion condition. Preoperative versus postoperative neurologic function and clinical outcome were evaluated using scoring systems such as the Japanese Orthopedic Association (JOA score), Neck Disability Index (NDI score) and 36-Item Short-Form Health Survey (SF-36 score).
There were no significant differences in JOA scores, NDI scores and SF-36 scores of the pairwise comparison among the three groups. The complications in our series included graft migration, collapse or displacement, hoarseness, dysphagia, C5 palsy, cerebral fluid leakage and wound infection. Sixty-one patients developed complications after surgery and the rate of complication was 21.33 %. Patients in the long corpectomy group had the highest rate of complications; the other two groups had a much lower rate of complications by the latest follow-up. The patients in the multilevel ACDF group had the highest fusion rate by the last follow-up. Patients who had C2-3 and C3-4 segments involved had a higher rate of postoperative hoarseness and dysphagia.
Most of the complications of the three reconstructive techniques subsided gradually after conservative treatment; none of them needed revision surgery. The multilevel ACDF approach has the lowest rate of non-union, but a slightly higher morbidity of the laryngeal nerve-related complication if proximal segments were involved. The long corpectomy approach should be selected prudently because of the high rate of complication.
前路手术广泛应用于多节段脊髓型颈椎病的外科治疗。前路减压后，许多不同的重建技术（多节段 ACDF、杂交结构和长椎体切除术）都取得了满意的结果。然而，很少有研究关注这三种重建技术的比较。本回顾性研究旨在分析这三种不同方法的并发症。
本研究回顾性分析了 2005 年至 2010 年间接受前路颈椎手术的 286 例多节段 CSM 患者的并发症。该病例系列包括 166 名男性和 120 名女性，手术时平均年龄为 53.8 岁（33 至 74 岁）。术后第 1 天进行影像学评估，术后 3、12 和 24 个月加摄颈椎屈伸位 X 线片，评估融合情况。采用日本骨科协会（JOA 评分）、颈部残疾指数（NDI 评分）和 36 项简明健康调查（SF-36 评分）等评分系统评估术前与术后神经功能和临床结果。
三组间 JOA 评分、NDI 评分和 SF-36 评分的两两比较差异均无统计学意义。本系列并发症包括植骨移位、塌陷或移位、声音嘶哑、吞咽困难、C5 神经病、脑脊液漏和伤口感染。术后 61 例患者发生并发症，并发症发生率为 21.33%。长椎体切除术组患者的并发症发生率最高，而另两组患者在末次随访时并发症发生率较低。多节段 ACDF 组患者的融合率在末次随访时最高。累及 C2-3 和 C3-4 节段的患者术后声音嘶哑和吞咽困难的发生率较高。
三种重建技术的大多数并发症经保守治疗后逐渐缓解，无需再次手术。多节段 ACDF 术式的不愈合率最低，但近端节段受累时，与喉返神经相关并发症的发病率略高。长椎体切除术的并发症发生率较高，应谨慎选择。
