Burkhardt Benedikt W, Brielmaier Moritz, Schwerdtfeger Karsten, Sharif Salman, Oertel Joachim M
Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
World Neurosurg. 2016 Jun;90:244-250. doi: 10.1016/j.wneu.2016.02.074. Epub 2016 Mar 3.
Anterior cervical discectomy and fusion with plate stabilization (ACDF+PS) is an accepted surgical procedure. We sought to evaluate the long-term clinical results of ACDF+PS with a special focus on pain, functional outcome, and adjacent segment disease.
Retrospectively, 139 patients who underwent ACDF+PS were reviewed with a standardized questionnaire including the current neurologic status, Neck Disability Index, EuroQuol-5 Dimension, Patient Satisfaction Index, Hospital Anxiety and Depression Scale, the Odom criteria, complications at the iliac crest donor side, and limitations in quality of life.
Mean follow-up time was 22 years (range: 17-34 years). Sixty five (46.8%) patients were evaluated by completed questionnaires, and 74 (53.2%) did not participate. Forty-six patients attended a physical examination. ACDF+PS were performed at 1 level in 28 patients, at 2 levels in 29 patients, and at 3 levels in 8 patients. Fifty (83.3%) of the patients with preoperative pain remained free of pain and did not require another procedure as the result of degenerative cervical disease. The mean NDI was 14%; according to the Odom criteria 86.2% of patients reported good-to-excellent functional recovery. A total of 100% of patients were satisfied or very satisfied with their outcome and would decide to undergo ACDF+PS again. Two developed adjacent segment disease and needed a second procedure.
ACDF+PS resulted in a significant increase in function, pain relief, and to a high degree of patient satisfaction. The rate for symptomatic adjacent segment disease was 4.5% after 20 years' follow-up.
颈椎前路椎间盘切除融合钢板内固定术（ACDF+PS）是一种公认的外科手术。我们旨在评估ACDF+PS的长期临床效果，特别关注疼痛、功能结局和相邻节段疾病。
回顾性分析139例行ACDF+PS手术的患者，采用标准化问卷进行评估，内容包括当前神经功能状态、颈部功能障碍指数、欧洲五维健康量表、患者满意度指数、医院焦虑抑郁量表、奥多姆标准、髂嵴供区并发症以及生活质量受限情况。
平均随访时间为22年（范围：17 - 34年）。65例（46.8%）患者通过完整问卷进行了评估，74例（53.2%）未参与。46例患者接受了体格检查。28例患者在1个节段行ACDF+PS手术，29例在2个节段，8例在3个节段。术前有疼痛的患者中，50例（83.3%）术后无疼痛，且无需因退行性颈椎疾病再次手术。平均颈部功能障碍指数为14%；根据奥多姆标准，86.2%的患者报告功能恢复良好至优秀。100%的患者对其手术结果满意或非常满意，愿意再次接受ACDF+PS手术。2例出现相邻节段疾病，需要再次手术。
ACDF+PS手术使功能显著改善、疼痛缓解，并使患者满意度达到很高水平。随访20年后，有症状的相邻节段疾病发生率为4.5%。
