Mobbs Ralph J, Li Jia Xi Julian, Phan Kevin
Department of Neurosurgery, Prince of Wales Private Hospital, Neuro Spine Clinic, Sydney, Australia.
Department of Neurosurgery, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Asian Spine J. 2017 Dec;11(6):943-950. doi: 10.4184/asj.2017.11.6.943. Epub 2017 Dec 7.
Retrospective case series.
This study aims to present the early clinical and radiological outcomes of anterior longitudinal ligament (ALL) reconstruction following disc arthroplasty.
Although cervical and lumbar disc arthroplasty have entered the clinical setting, there are still concerns regarding the short and long term complications arising from hypermobility of current prosthesis designs. Reconstruction of the ALL is a potential solution to disc arthroplasty hypermobility.
ALL reconstruction following disc arthroplasty have been performed by the senior author over a 24 month period. Ligament replacements used include allograft and synthetic, ligament advanced reinforcement system (LARS) ligaments. Methods of fixation used include titanium staples, bone anchors and suture fixation. Radiological follow-up pre- and postoperative Oswestry disability index, Neck Disability Index, Patient Satisfaction index scores were recorded on all patients.
A total of 18 ALL reconstructions were performed. There have been no cases of early complications, revision surgery for recurrent symptoms or implant failure. Of the 6 patients receiving a minimum of 15 months follow-up, 4 patients received an allograft, 2 patients received the LARS ligament. Favourable, postoperative clinical and radiographic outcomes have been demonstrated.
ALL reconstruction following cervical and lumbar disc arthroplasty is a promising solution to addressing non-physiological kinematics of current disc arthroplasty devices. Randomized, controlled studies with larger study samples and long-term follow-up are required to establish these conclusions.
回顾性病例系列研究。
本研究旨在呈现椎间盘置换术后前纵韧带（ALL）重建的早期临床和影像学结果。
尽管颈椎和腰椎间盘置换术已进入临床应用，但对于当前假体设计导致的活动度过高所引发的短期和长期并发症仍存在担忧。ALL重建是解决椎间盘置换术活动度过高问题的一种潜在方法。
资深作者在24个月期间对椎间盘置换术后的ALL重建进行了研究。使用的韧带替代物包括同种异体移植物和合成韧带，即韧带增强修复系统（LARS）韧带。使用的固定方法包括钛钉、骨锚和缝线固定。记录所有患者术前和术后的影像学随访结果、Oswestry功能障碍指数、颈部功能障碍指数、患者满意度指数评分。
共进行了18例ALL重建手术。未出现早期并发症、因症状复发进行翻修手术或植入物失败的病例。在6例接受至少15个月随访的患者中，4例接受了同种异体移植物，2例接受了LARS韧带。术后临床和影像学结果均良好。
颈椎和腰椎间盘置换术后的ALL重建是解决当前椎间盘置换装置非生理性运动学问题的一种有前景的方法。需要进行更大样本量且长期随访的随机对照研究来证实这些结论。
