Chen Bin-Hui, Gu Shi-Rong, Zhang Ming, Sang Pei-Ming, Li Jie
Zhongguo Gu Shang. 2014 Feb;27(2):132-6.
To analyze the reasons why anterior decompression and titanium mesh fusion for cervical spondylosis always show poor therapeutic effects, and to investigate the clinical effects of anterior revision surgery in these patients.
From January 2004 to December 2011, 16 patients underwent anterior decompression and titanium mesh fusion for cervical myelopathy were treated with anterior revision surgery. There were 7 males and 9 females with an average age of 61 years old (ranged from 46 to 75 years), including 11 cases with cervical spondylotic myelopathy, 2 cases with nerve root cervical spondylosis and 3 cases with mixed type cervical spondylosis. Average duration from the first operation to reoperation was 7 years(ranged from 4 to 12 years). In the first operation, titanium mesh segment located in C3-C5 (2 cases), C4-C6 (8 cases), C4-C7 (2 cases), C5-C7 (4 cases), and one of them, titanium mesh implantation in C4 and C5,6 intervertebral disk removal and cage fusion. After the first operation, symptom of 13 patients recurred after improvement or disappearance, 2 patients did not show obvious improvement, and 1 patient aggravated. Cervical spine radiography, CT scan and MRI were performed in all patients before re-operation. There were 12 patients with compression of the spinal cord or nerve root caused by degenerative changes in adjacent segments of fusion segments, 4 cases in upper segments, and 8 cases in lower segments; 3 patients with compression of the spinal cord or nerve root caused by vertebral posterior osteophyte of decompressed segments; 1 patient with compression of the spinal cord caused by incomplete anterior decompression. JOA, NDI and Odom classification were used to assess the clinical effects.
All anterior revision surgery were successful with a mean time of 110 min (80 to 150 min) and mean bleeding of 160 ml (30 to 200 ml). There was 30 ml clear drainage fluid in 1 patient suspected of cerebrospinal fluid leakage. But the 2nd day after operation, the tube was removed and the drainage opening was sutured, and the suture incision healed in grade A after 10 days. Other patients had no complications such as dysdipsia, hoarseness, and laryngeal edema, etc. All patients were followed up for 12 to 28 months with an average of 16 months. Two months after operation and at last follow-up, JOA scores and ODI index had obviously improved than preoperation (P < 0.01), and there was significant difference between postoperative 2 months and last follow-up (P < 0.01). At the final follow-up, improvement rate of JOA was (72.9 +/- 0.2)%. According to the standard of Odom, 12 cases got excellent results, 3 good, 1 fair.
After surgery of cervical decompression and bone graft fusion with titanium mesh, the patients need re-operation because of incomplete decompression, degenerative changes in adjacent segments or newly formed compression factors, and complications caused by implants. Anterior revision surgery can obtain good clinical effects.
分析颈椎病前路减压钛网融合术后疗效不佳的原因，探讨此类患者行前路翻修手术的临床效果。
2004年1月至2011年12月，对16例行颈椎病前路减压钛网融合术后患者行前路翻修手术。男7例，女9例，平均年龄61岁（46～75岁），其中脊髓型颈椎病11例，神经根型颈椎病2例，混合型颈椎病3例。首次手术至再次手术平均间隔7年（4～12年）。首次手术钛网位置：C3～C5 2例，C4～C6 8例，C4～C7 2例，C5～C7 4例，其中1例于C4、C5行钛网植入、6椎间盘切除及椎间融合。首次手术后，13例患者症状改善或消失后复发，2例改善不明显，1例加重。再次手术前行颈椎X线、CT及MRI检查。因融合节段相邻节段退变致脊髓或神经根受压12例，其中上位节段4例，下位节段8例；减压节段椎体后缘骨赘致脊髓或神经根受压3例；前路减压不彻底致脊髓受压1例。采用JOA、NDI及Odom分级评估临床效果。
所有前路翻修手术均成功，平均手术时间110分钟（80～150分钟），平均出血量160毫升（30～200毫升）。1例怀疑脑脊液漏患者术后引流出30毫升清亮引流液，术后第2天拔除引流管并缝合引流口，10天后切口甲级愈合。其余患者无吞咽困难、声音嘶哑、喉水肿等并发症。所有患者随访12～28个月，平均16个月。术后2个月及末次随访时JOA评分及ODI指数较术前明显改善（P<0.01），术后2个月与末次随访比较差异有统计学意义（P<0.01）。末次随访时JOA改善率为（72.9±0.2）%。按Odom标准评定：优12例，良3例，可1例。
颈椎病前路减压植骨钛网融合术后因减压不彻底、相邻节段退变或新生致压因素及内植物相关并发症等需再次手术，前路翻修手术可获得良好临床效果。
