Zeng Junfeng, Duan Yuchen, Yang Yi, Wang Beiyu, Hong Ying, Lou Jigang, Ning Ning, Liu Hao
Department of Orthopedics Department of Operation room, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2018 Feb;97(5):e9724. doi: 10.1097/MD.0000000000009724.
Anterior cervical corpectomy and fusion (ACCF) is an effective surgical technique for cervical spondylotic myelopathy (CSM). However, no data exist regarding long-term outcomes after ACCF with the dynamic cervical plate for CSM. This study aimed to provide minimum 5-year clinical and radiographic outcomes of anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage (TMC) for CSM.Thirty-five patients who underwent single- or 2-level ACCF with dynamic cervical plate and TMC for the treatment of CSM were retrospectively investigated. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. Radiographic evaluations included TMC subsidence, fusion status, cervical lordosis, segmental angle, and segmental height.Twenty-eight patients underwent single-level and 7 patients underwent 2-level corpectomy with a mean follow-up period of 69.5 months. The average preoperative JOA score was 11.3 ± 3.0 and improved significantly to 14.2 ± 2.0 at the last follow-up (P < .001). Both cervical lordosis (P = .013) and segmental angle (P = .001) were significantly increased toward lordosis at the last follow-up. The TMC subsidence rate was 31.4% (n = 11) at the last follow-up. There was no significant difference in JOA recovery rate between subsidence and no subsidence group (P = .43). All patients obtained solid fusion at 1-year follow-up.Anterior corpectomy and reconstruction with dynamic cervical plate and TMC might be an effective method for the treatment of CSM at a minimum 5-year follow-up. It can maintain or restore cervical sagittal alignment. Subsidence of the TMC did not influence the clinical outcome.
颈椎前路椎体次全切除融合术(ACCF)是治疗脊髓型颈椎病(CSM)的一种有效手术技术。然而,关于使用动力颈椎板行ACCF治疗CSM后的长期疗效尚无相关数据。本研究旨在提供使用动力颈椎板和钛网笼(TMC)进行颈椎前路椎体次全切除及重建治疗CSM至少5年的临床和影像学结果。对35例行单节段或双节段ACCF并使用动力颈椎板和TMC治疗CSM的患者进行回顾性研究。采用日本骨科协会(JOA)评分评估临床疗效。影像学评估包括TMC沉降、融合状态、颈椎前凸、节段角度和节段高度。28例患者行单节段椎体次全切除术,7例患者行双节段椎体次全切除术,平均随访时间为69.5个月。术前平均JOA评分为11.3±3.0,末次随访时显著提高至14.2±2.0(P<0.001)。末次随访时,颈椎前凸(P=0.013)和节段角度(P=0.001)均显著向脊柱前凸方向增加。末次随访时TMC沉降率为31.4%(n=11)。沉降组和未沉降组的JOA恢复率无显著差异(P=0.43)。所有患者在1年随访时均获得牢固融合。使用动力颈椎板和TMC进行颈椎前路椎体次全切除及重建可能是治疗CSM至少5年随访期内的一种有效方法。它可以维持或恢复颈椎矢状位对线。TMC沉降不影响临床疗效。