Jang Jae-Won, Lee Jung-Kil, Lee Jung-Heon, Hur Hyuk, Kim Tae-Wan, Kim Soo-Han
Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju 501-757, Republic of Korea.
Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju 501-757, Republic of Korea.
J Clin Neurosci. 2014 Oct;21(10):1779-85. doi: 10.1016/j.jocn.2014.02.016. Epub 2014 Jun 21.
Subsidence after anterior cervical reconstruction using a titanium mesh cage (TMC) has been a matter of debate. The authors investigated and analyzed subsidence and its effect on clinical and radiologic parameters after cervical reconstruction using a TMC for degenerative cervical disease. Thirty consecutive patients with degenerative cervical spine disorders underwent anterior cervical corpectomy followed by reconstruction with TMC. Twenty-four patients underwent a single-level corpectomy, and six patients underwent a two-level corpectomy. Clinical outcomes were assessed using a Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI). Fusion status, anterior and posterior subsidence of the TMC, segmental angle (SA) and cervical sagittal angle (CSA) were assessed by lateral and flexion-extension radiographs of the neck. The mean follow-up period was 27.6 months (range, 24 to 49 months). The VAS, NDI and JOA scores were all significantly improved at the last follow-up. No instances of radiolucency or motion-related pseudoarthrosis were detected on radiographic analysis, yielding a fusion rate of 100%. Subsidence occurred in 28 of 30 patients (93.3%). The average anterior subsidence of the cage was 1.4 ± 0.9 mm, and the average posterior subsidence was 2.9 ± 1.2 mm. The SA and CSA at the final follow-up were significantly increased toward a lordotic angle. Anterior cervical reconstruction using TMC and plating in patients with cervical degenerative disease provides good clinical and radiologic outcomes. Cage subsidence occurred frequently, especially at the posterior part of the cage. Despite the prominent posterior subsidence of the TMC, SA and CSA were improved on final follow-up radiographs, suggesting that posterior subsidence may contribute to cervical lordosis.
使用钛网笼（TMC）进行颈椎前路重建后的下沉一直是一个有争议的问题。作者对使用TMC治疗退变性颈椎疾病进行颈椎重建后的下沉情况及其对临床和放射学参数的影响进行了调查和分析。连续30例退变性颈椎疾病患者接受了颈椎前路椎体次全切除，随后用TMC进行重建。24例患者接受了单节段椎体次全切除，6例患者接受了双节段椎体次全切除。使用视觉模拟量表（VAS）、日本骨科协会（JOA）评分和颈部功能障碍指数（NDI）评估临床结果。通过颈部的侧位和屈伸位X线片评估融合状态、TMC的前后下沉、节段角（SA）和颈椎矢状角（CSA）。平均随访期为27.6个月（范围24至49个月）。在最后一次随访时，VAS、NDI和JOA评分均显著改善。影像学分析未发现透亮区或与运动相关的假关节病例，融合率为100%。30例患者中有28例（93.3%）发生下沉。椎间融合器的平均前向下沉为1.4±0.9mm，平均后向下沉为2.9±1.2mm。最后一次随访时的SA和CSA向生理前凸角显著增加。对患有颈椎退变性疾病的患者使用TMC和钢板进行颈椎前路重建可提供良好的临床和影像学结果。椎间融合器下沉频繁发生，尤其是在椎间融合器的后部。尽管TMC后向下沉明显，但在最后一次随访X线片上SA和CSA有所改善，提示后向下沉可能有助于颈椎生理前凸。
