Luo Jiaquan, Huang Sheng, Gong Ming, Li Liangping, Yu Ting, Zou Xuenong
Department of Spine Surgery/Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China,
Eur J Orthop Surg Traumatol. 2015 Jul;25 Suppl 1:S147-53. doi: 10.1007/s00590-015-1613-6. Epub 2015 Mar 4.
Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical procedure for the treatment of cervical degenerative disk diseases (CDDD). The purpose of our study was to investigate the reliability and efficacy of ACDF using self-locking stand-alone polyetheretherketone (PEEK) cages, with two anchoring clips placed in the upper and lower vertebrae, respectively.
Twenty-six patients who underwent ACDF using a stand-alone PEEK cage packed with local osteophytes and cancellous allograft bone from January 2010 to January 2012 were enrolled in this study. Clinical findings were assessed using a visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and Odom criteria. Intervertebral height and cervical fusion status were assessed on X-ray.
Twenty-six patients underwent ACDF using a stand-alone PEEK cervical cage. All patients had a minimum 2 years of follow-up. The operative levels were C3/4, C4/5 in seven patients, C4/5, C5/6 in 13 patients, and C4/5, C6/7 in six patients. At 3 days, 6 months, and 2 years of follow-ups, the JOA scores were 10.41 ± 1.67, 13.78 ± 1.91, 14.42 ± 2.09, respectively, which was significantly higher (p < 0.01) than preoperative (7.34 ± 1.71), whereas VAS overall pain score was 4.35 ± 1.32, 1.73 ± 0.44, 1.32 ± 0.57, respectively, which was significantly lower (p < 0.01) than preoperative (8.01 ± 1.16). The NDI preoperatively was 33.94 ± 11.75, 23.53 ± 10.92 at 3 days postoperatively, 12.64 ± 8.36 at 6 months, and 10.74 ± 7.92 at 2 years of follow-ups. Intervertebral height was 5.99 ± 0.31 mm preoperatively, 8.70 ± 0.23 mm at 3 days, 8.34 ± 0.61 mm at 6 months, and 8.22 ± 0.35 mm at 2 years of follow-ups. According to Odom criteria, 10 patients (38.4%) presented with an excellent clinical outcome, 15 good (57.6%), 1 fair (3.8%), and no patient presented a poor outcome. Solid fusion was achieved in all patients (100%) at a mean time of 4.5 months.
ACDF using a self-locking stand-alone PEEK cage with two anchoring clips placed in the upper and lower vertebrae, respectively, could be considered a safe and effective substitute for fusion in patients with two-level CDDD; it can effectively restore the intervertebral height, facilitate radiologic follow-up, cause few complications, and lead to satisfactory outcomes.
颈椎前路椎间盘切除融合术（ACDF）是治疗颈椎退行性椎间盘疾病（CDDD）广泛接受的外科手术。我们研究的目的是探讨使用自锁独立聚醚醚酮（PEEK）椎间融合器，分别在上、下椎体放置两个锚定夹的ACDF的可靠性和疗效。
本研究纳入了2010年1月至2012年1月期间接受使用填充局部骨赘和同种异体松质骨的独立PEEK椎间融合器进行ACDF手术的26例患者。使用视觉模拟量表（VAS）、日本骨科协会（JOA）评分、颈部功能障碍指数（NDI）和奥多姆标准评估临床结果。通过X线评估椎间高度和颈椎融合情况。
26例患者接受了使用独立PEEK颈椎椎间融合器的ACDF手术。所有患者均至少随访2年。手术节段为7例患者的C3/4、C4/5，13例患者的C4/5、C5/6，6例患者的C4/5、C6/7。在术后3天、6个月和2年的随访中，JOA评分分别为10.41±1.67、13.78±1.91、14.42±2.09，显著高于术前（7.34±1.71）（p<0.01），而VAS总体疼痛评分分别为4.35±1.32、1.73±0.44、1.32±0.57，显著低于术前（8.01±1.16）（p<0.01）。术前NDI为33.94±11.75，术后3天为23.53±10.92，6个月时为12.64±8.36，2年随访时为10.74±7.92。术前椎间高度为5.99±0.31mm，术后3天为8.70±0.23mm，6个月时为8.34±0.61mm，2年随访时为8.22±0.35mm。根据奥多姆标准，10例患者（38.4%）临床结果优秀，15例良好（57.6%），1例一般（3.8%），无患者结果差。所有患者（100%）均实现了牢固融合，平均时间为4.5个月。
对于双节段CDDD患者，使用分别在上、下椎体放置两个锚定夹的自锁独立PEEK椎间融合器进行ACDF可被视为一种安全有效的融合替代方法；它能有效恢复椎间高度，便于影像学随访，并发症少，结果满意。
