Reyes Sánchez Alejandro Antonio, Gameros Castañeda Luis Alberto, Obil Chavarría Claudia, Alpizar Aguirre Armando, Zárate Kalfópulos Barón, Rosales-Olivares Luis Miguel
División de Cirugía de Columna Vertebral, Instituto Nacional de Rehabilitación, Secretaria de Salud, Ciudad de México, México.
División de Cirugía de Columna Vertebral, Instituto Nacional de Rehabilitación, Secretaria de Salud, Ciudad de México, México.
Cir Cir. 2017 Sep-Oct;85(5):381-386. doi: 10.1016/j.circir.2016.10.011. Epub 2017 Jan 16.
Cervical spondylotic myelopathy is caused by cervical stenosis. Several techniques have been described for the treatment of multilevel disease, such as the anterior corpectomy with titanium mesh cage and anterior cervical plate placement, which has the advantage of performing a wider decompression and using the same bone as graft. However, it has caused controversy since the collapse of the mesh cage continues being a major limitation of this procedure.
A prospective 4-year follow-up study was conducted in 7 patients diagnosed with cervical stenosis, who were treated surgically by one level corpectomy with titanium mesh cage and anterior cervical plate placement, evaluating them by radiographs and clinical scales.
7 patients, 5 women and 2 males were studied. The most common level was C5 corpectomy (n=4). The Neck Disability Index (NDI) preoperative average was 30.01±24.32 and 4-year postoperative 16.90±32.05, with p=0.801. The preoperative and 4-year postoperative Nürick was 3.28± 48 and 3.14±1.21 respectively, with p=0.766. Preoperative lordosis was 14.42±8.03 and 4-year postoperative 17±11.67 degrees, with p=0.660. The immediate postoperative and 4-year postoperative subsidence was 2.69±2.8 and 6.11±1.61 millimeters respectively, with p=0.0001.
Despite the small sample, the subsidence of the mesh cage is common in this procedure. No statistically significant changes were observed in the lordosis or Nürick scale and NDI.
脊髓型颈椎病由颈椎管狭窄引起。已经描述了几种治疗多节段疾病的技术,例如前路椎体次全切除钛网融合器植入联合前路颈椎钢板内固定术,该技术具有减压范围广以及使用自体骨作为植骨材料的优点。然而,由于钛网融合器下沉仍然是该手术的主要局限性,因此引发了争议。
对7例诊断为颈椎管狭窄的患者进行了为期4年的前瞻性随访研究,这些患者接受了单节段椎体次全切除钛网融合器植入联合前路颈椎钢板内固定术,并通过X线片和临床量表对其进行评估。
共研究了7例患者,其中5例女性,2例男性。最常见的手术节段是C5椎体次全切除(n = 4)。术前颈部功能障碍指数(NDI)平均为30.01±24.32,术后4年为16.90±32.05,p = 0.801。术前和术后4年的Nürick分级分别为3.28±1.48和3.14±1.21,p = 0.766。术前颈椎前凸为14.42±8.03,术后4年为17±11.67度,p = 0.660。术后即刻和术后4年钛网融合器下沉分别为2.69±2.8和6.11±1.61毫米,p = 0.0001。
尽管样本量小,但在该手术中钛网融合器下沉很常见。在颈椎前凸、Nürick分级和NDI方面未观察到统计学上的显著变化。