Choi Man Kyu, Kim Sung Bum, Lee Jun Ho
Department of Neurosurgery, Daegu Catholic University Medical Center, College of Medicine, Catholic University of Daegu, Daegu, Korea.
Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2018 Jul;61(4):530-536. doi: 10.3340/jkns.2017.0186. Epub 2018 Apr 10.
We present two cases of unexpected postoperative intractable cervicalgia due to over-sized implant insertion during simple anterior cervical decompression and fusion (ACDF) or artificial disc replacement (ADR). These patients experienced severe cervicalgia mostly related to their neck motion even after standard cervical operations. In both cases, the restored disc heights after the operations were prominently greater than the preoperative disc heights. The patients had not responded to any of the conservative treatments, and unloading of these excessively distracted segments through ultimate revision surgery led to dramatic pain relief. This report emphasizes the increase in distractional forces that takes place after a standard ACDF or ADR, as well as the importance of a proper sized implant. It also includes the reviews of other biomechanical or clinical reports dealing with this issue, thereby cautioning the surgeons not to disregard these factors, which might have an adverse effect in patients with cervicalgia even after radiographically successful cervical procedures.
我们报告了两例在单纯前路颈椎减压融合术（ACDF）或人工椎间盘置换术（ADR）期间因植入物尺寸过大而导致术后意外出现顽固性颈痛的病例。这些患者即使在接受标准颈椎手术后，仍经历严重的颈痛，且大多与颈部活动有关。在这两例病例中，术后恢复的椎间盘高度显著高于术前椎间盘高度。患者对任何保守治疗均无反应，通过最终翻修手术减轻这些过度撑开节段的压力后，疼痛得到显著缓解。本报告强调了标准ACDF或ADR术后牵张力的增加，以及合适尺寸植入物的重要性。报告还纳入了其他关于此问题的生物力学或临床报告的综述，从而提醒外科医生不要忽视这些因素，因为即使颈椎手术在影像学上取得成功，这些因素也可能对颈痛患者产生不利影响。
