Burkhardt Benedikt W, Brielmaier Moritz, Schwerdtfeger Karsten, Sharif Salam, Oertel Joachim M
Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstrasse 100, Building 90.5, 66421, Homburg, Saar, Germany.
Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Eur Spine J. 2017 Apr;26(4):1246-1253. doi: 10.1007/s00586-017-4988-8. Epub 2017 Feb 9.
The purpose of this study was to assess long-term follow-up data after anterior cervical decompression and fusion (ACDF) with and without Caspar plating (ACDF + PS) for the treatment of cervical spondylotic myelopathy (CSM) with special focus on functional outcome, pain, and repeat surgery for adjacent segment disease (ASD).
Hospital records of 45 patients who were affected by CSM and underwent ACDF or ACDF + PS at least 17 years ago were reviewed. Information about diagnosis, surgical report, pre- and postoperative clinical process, and complications was analyzed. Clinical outcome was assessed using a standardized questionnaire including the Neck Disability Index (NDI), modified JOA-score, Odom's criteria, limitations in quality of life, and questions about the current neurological status and pain.
Twenty-three patients with a mean follow-up of 26 years were evaluated. ACDF was performed in nine and ACDF + PS in 14 patients, respectively. At follow-up 78.3% of patients were free of pain, 91.3% had no motor deficit, 73.9% had no sensory deficit, and 60.7% had no gait disturbance. The current mean NDI is 14% (range 2-44%), the mean modified JOA-score was 17.2 (range 15-18). According to Odom's criteria 78.3% of patients had clinical success. In four patients repeat surgery was indicated due to pseudarthrosis or symptomatic ASD (17.4%).
ACDF and ACDF + PS yield significant decrease in neck pain, a significant increase in sensorimotor function and a high rate of clinical success. Patients with preoperative gait disturbance completely recovered in about 60% of cases. Overall prevalence for ASD was 17.4% after 25 years.
本研究旨在评估前路颈椎减压融合术（ACDF）在有或没有使用卡斯帕钢板（ACDF + PS）治疗脊髓型颈椎病（CSM）后的长期随访数据，特别关注功能结局、疼痛以及相邻节段疾病（ASD）的再次手术情况。
回顾了45例至少在17年前患有CSM并接受ACDF或ACDF + PS手术患者的医院记录。分析了有关诊断、手术报告、术前和术后临床过程以及并发症的信息。使用标准化问卷评估临床结局，该问卷包括颈部功能障碍指数（NDI）、改良JOA评分、奥多姆标准、生活质量限制以及有关当前神经状态和疼痛的问题。
对23例平均随访26年的患者进行了评估。分别有9例患者接受了ACDF手术，14例患者接受了ACDF + PS手术。随访时，78.3%的患者无疼痛，91.3%的患者无运动功能障碍，73.9%的患者无感觉功能障碍，60.7%的患者无步态障碍。当前平均NDI为14%（范围2 - 44%），平均改良JOA评分为17.2（范围15 - 18）。根据奥多姆标准，78.3%的患者临床治疗成功。4例患者因假关节形成或有症状的ASD而需要再次手术（17.4%）。
ACDF和ACDF + PS可显著减轻颈部疼痛，显著提高感觉运动功能，且临床成功率高。术前有步态障碍的患者约60%完全康复。25年后ASD的总体患病率为17.4%。
