Ando Kei, Imagama Shiro, Ito Zenya, Kobayashi Kazuyoshi, Yagi Hideki, Shinjo Ryuichi, Hida Tetsuro, Ito Kenyu, Ishikawa Yoshimoto, Ishiguro Naoki
The Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Clin Spine Surg. 2017 Jun;30(5):E628-E632. doi: 10.1097/BSD.0000000000000199.
Retrospective clinical study.
To evaluate the clinical outcome of patients who had undergone occipitocervical (OC) fusion using pedicle screws and rods over a minimum 5-year follow-up.
Few studies have evaluated occipitocervical (OC) fusion using pedicle screws and rods for long-term follow-up.
Twenty-seven consecutive patients treated underwent posterior OC fusion using pedicle screws and rods over a minimum 5-year follow-up. The Modified McCormick scale to grade a patient's functional status and the Japanese Orthopaedic Association (JOA) scoring system were used to evaluate preoperative and postoperative neurological function. We assessed fusion by both direct and indirect evidence; bony trabeculae at the graft-recipient interface on lateral cervical radiographs and sagittal computed tomography reconstruction was considered direct evidence of union.
The mean follow-up period was 7.2 years (5-14 y). JOA scores were 8.1±3.8 before surgery and 11.7±3.7 at the final follow-up. The recovery rate calculated from the JOA scores was 42.0±30.0%. Functional status did improve at least 1 grade according to the modified McCormick scale in 18 patients (66.7%). There was no deterioration at the final follow-up.There were postoperative implant-related complications in 8 patients (29.6%): loosening of pedicle screws in 2, rod breakage in 2, plate breakage in 1, screw breakage in 1, pullout of pedicle screws in 1, and wiring induced myelopathy in 1 patient. The average duration between surgery and implant failure was 31.2 months (12-60 mo) except for 2.
Sufficient bone grafting, proper decortication of the bone bed, using thicker and high stiffness rods, and ultra-high molecular weight polyethylene tape as a fixation or reinforcement of implant may help prevent implant failure.
回顾性临床研究。
评估接受枕颈（OC）椎弓根螺钉和棒融合术且随访至少5年的患者的临床结局。
很少有研究对枕颈（OC）椎弓根螺钉和棒融合术进行长期随访评估。
27例连续接受治疗的患者接受了枕颈后路椎弓根螺钉和棒融合术，随访至少5年。采用改良麦考密克量表对患者功能状态进行分级，并使用日本骨科协会（JOA）评分系统评估术前和术后神经功能。我们通过直接和间接证据评估融合情况；颈椎侧位X线片和矢状面计算机断层扫描重建图像上植骨受体界面处的骨小梁被视为融合的直接证据。
平均随访期为7.2年（5 - 14年）。术前JOA评分为8.1±3.8，末次随访时为11.7±3.7。根据JOA评分计算的恢复率为42.0±30.0%。根据改良麦考密克量表，18例患者（66.7%）的功能状态至少改善了1级。末次随访时无病情恶化。8例患者（29.6%）出现术后植入物相关并发症：2例椎弓根螺钉松动，2例棒断裂，1例钢板断裂，1例螺钉断裂，1例椎弓根螺钉拔出，1例患者出现钢丝诱导性脊髓病。除2例患者外，手术与植入物失效之间的平均时间为31.2个月（12 - 60个月）。
充分的植骨、对骨床进行适当的去皮质处理、使用更厚且刚度高的棒以及使用超高分子量聚乙烯带作为植入物的固定或加强材料可能有助于预防植入物失效。
