Burkhardt Benedikt W, Brielmaier Moritz, Schwerdtfeger Karsten, Oertel Joachim M
Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Saar, Germany.
Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrbergerstraße 100, Gebäude 90.5, 66421, Homburg, Germany.
Neurosurg Rev. 2018 Apr;41(2):473-482. doi: 10.1007/s10143-017-0872-6. Epub 2017 Jun 23.
Extreme long-term clinical outcome studies following anterior cervical discectomy and fusion (ACDF) with an autologous iliac crest with and without Caspar plating (ACDF + CP) for the treatment of radiculopathy caused by cervical disc herniation (CDH) are extremely rare. Hospital records of patients who underwent ACDF or ACDF + CP for the treatment of CDH at least 17 years ago were reviewed. Information about diagnosis, surgery, pre- and postoperative clinical process, and repeated procedure was analyzed. At final follow-up, patients were reviewed with a standardized questionnaire including the current neurological status, Neck Disability Index (NDI), Odom's criteria, a modified EQ-5D, and limitations in quality of life. One hundred twenty-two patients with a mean follow-up of 25 years were evaluated. ACDF was performed in 80 and ACDF + CP in 42 patients, respectively. At final follow-up, 81.1% of patients were free of radicular pain and had no repeated procedure. According to Odom's criteria, 86.1% of good to excellent functional recovery was noted. The mean NDI and EQ-5D was 14% and 5 points, respectively. There was no significant difference in the assessed clinical outcome parameters between patients treated with ACDF and ACDF + CP. The rate for repeated procedure due to degenerative cervical disorders was 10.7 and 7.4% due to symptomatic adjacent segment disease with 25 years. ACDF and ACDF + CP achieved a high rate radicular pain relief (89.3%) and clinical success (86.1%) for the treatment of CDH within a 25 years follow-up. No statistical difference concerning clinical outcome and rate of repeated procedure was detected.
关于采用带或不带Caspar钢板的自体髂嵴前路颈椎间盘切除融合术（ACDF + CP）治疗颈椎间盘突出症（CDH）所致神经根病的极长期临床结局研究极为罕见。回顾了至少17年前接受ACDF或ACDF + CP治疗CDH的患者的医院记录。分析了有关诊断、手术、术前和术后临床过程以及重复手术的信息。在最后随访时，使用标准化问卷对患者进行评估，问卷包括当前神经状态、颈部功能障碍指数（NDI）、奥多姆标准、改良的EQ - 5D以及生活质量限制。对122例平均随访25年的患者进行了评估。分别有80例患者接受了ACDF，42例患者接受了ACDF + CP。在最后随访时，81.1%的患者无神经根性疼痛且未进行重复手术。根据奥多姆标准，功能恢复良好至优秀的比例为86.1%。NDI和EQ - 5D的平均值分别为14%和5分。接受ACDF和ACDF + CP治疗的患者在评估的临床结局参数方面无显著差异。25年间，因退行性颈椎疾病进行重复手术的发生率为10.7%，因症状性相邻节段疾病进行重复手术的发生率为7.4%。在25年的随访中，ACDF和ACDF + CP治疗CDH均实现了较高的神经根性疼痛缓解率（89.3%）和临床成功率（86.1%）。未检测到临床结局和重复手术率方面的统计学差异。
