Albanese Vincenzo, Certo Francesco, Visocchi Massimiliano, Barbagallo Giuseppe M V
Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
World Neurosurg. 2017 Oct;106:724-735. doi: 10.1016/j.wneu.2017.06.051. Epub 2017 Jun 15.
In multilevel degenerative conditions posterior approaches are often preferred, but anterior approaches provide comparable clinical results and better alignment. Anterior plating entails higher rates of soft tissue injuries and dysphagia, particularly in multilevel cases. This study evaluates efficacy and safety of zero-profile devices in 3- and 4-level anterior cervical diskectomy and fusion, analyzing patients' clinical and radiologic long-term outcomes.
We prospectively enrolled 24 patients with cervical spondylotic myeloradiculopathy who underwent 3- and 4-level anterior cervical diskectomy and fusion with the zero-profile device. Mean follow-up was 39 months (range 24-72). Nurick grading was used for myelopathy, Neck Disability Index and Visual Analog Scale scores for arm and neck pain, and Short Form 36 survey for physical and mental health status. Postoperative radiograph and computed tomography were obtained after surgery, at 6 and 12 months, and at last follow-up to assess fusion rate and complications. Cervical alignment was measured by Cobb angle. Incidence of postoperative dysphagia was monitored according to Bazaz dysphagia index.
On last computed tomography scan, fusion was present in 49% of spaces (40 of 82). Mean neck and arm pain visual analog scale decreased from 6.7-1.6 (P < 0.01) and 5.9-0.9 (P < 0.01), respectively. Improvements in the Short Form 36 survey and Neck Disability Index were documented (P < 0.01). Lordosis was restored in all patients. Five of 24 patients complained of mild dysphagia (20.8%): in three (12.5%) short-term dysphagia and in two (8.3%) medium-term dysphagia. No long-term dysphagia (≥6 months) was observed.
Anterior cervical diskectomy and fusion with a zero-profile device is effective and safe for 3- and 4-level cervical spondylotic myeloradiculopathy. It allows to restore cervical lordosis and achieve long-term satisfactory clinical outcome.
在多节段退变疾病中，后路手术通常更受青睐，但前路手术能提供相当的临床效果且对线更好。前路钢板固定导致软组织损伤和吞咽困难的发生率更高，尤其是在多节段病例中。本研究评估零切迹装置在三、四节段颈椎前路椎间盘切除融合术中的有效性和安全性，分析患者的临床和影像学长期结果。
我们前瞻性纳入了24例患有脊髓型颈椎病神经根病的患者，他们接受了三、四节段颈椎前路椎间盘切除并使用零切迹装置进行融合。平均随访时间为39个月（范围24 - 72个月）。采用Nurick分级评估脊髓病，采用颈部残疾指数和视觉模拟量表评分评估手臂和颈部疼痛，采用简短健康调查问卷评估身心健康状况。术后在手术时、6个月、12个月及最后一次随访时获取X线片和计算机断层扫描，以评估融合率和并发症。通过Cobb角测量颈椎对线情况。根据Bazaz吞咽困难指数监测术后吞咽困难的发生率。
在最后一次计算机断层扫描时，82个间隙中有49%（40个）实现了融合。颈部和手臂疼痛视觉模拟量表评分分别从6.7降至1.�P < 0.01）和从5.9降至0.9（P < 0.01）。简短健康调查问卷和颈部残疾指数均有改善（P < 0.01）。所有患者的前凸均得以恢复。24例患者中有5例主诉轻度吞咽困难（20.8%）：3例（12.5%）为短期吞咽困难，2例（8.3%）为中期吞咽困难。未观察到长期吞咽困难（≥6个月）。
对于三、四节段脊髓型颈椎病神经根病，采用零切迹装置进行颈椎前路椎间盘切除融合术是有效且安全的。它能够恢复颈椎前凸并取得长期满意的临床效果。
