Liu H, Yue L, Chen S L, Hu B, Li C D, Yi X D, Li H, Lu H L, Wang Y, Yu Z R, Sun H L, Wang S J, Zhao Y, Qi L T, Wang R
Department of Orthopaedic Surgery, Peking University First Hospital, Beijing 100034, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2018 Apr 18;50(2):347-351.
To investigate the clinical effectiveness of polytheretherketone (PEEK) cages assisted anterior cervical discetomy and fusion (ACDF) to treat cervical spondylosis with sympathetic symptoms.
Retrospective analysis was undertaken for 39 patients who were diagnosed as cervical spondylosis with sympathetic symptoms and underwent ACDF with PEEK cages. Radiographs obtained before surgery, after surgery, and at the final follow-up were assessed for quality of fusion. The following criteria were used for assessing radiographic success of fusion: (1) endplate obliterated with no lucent lines; (2) obliteration of disc space by bony trabeculae; (3) less than 2°of intervertebral motion or 2 mm of motion between the spinous processes at the operated segment on flexion-extension lateral radiographs. The sympathetic symptoms including vertigo, headache, tinnitus, nausea and vomiting, heart throb, hypomnesia and gastroenterological discomfort were scored by 20-point system preoperatively, 2 months postoperatively and at the final follow-up. The recovery rate and clinical satisfaction rate were also evaluated. Surgical complications were also assessed.
They were followed up for at least one year. The mean follow-up was 15.6 months. Radiographs of the cervical spine at the last follow-up revealed a solid fusion with no signs of a pseudoarthrosis in 36 cases. In two patients delayed union and bony fusion were achieved at the end of 9 and 11 months. Pseudoarthosis was found in 1 case but the patient had no symptoms. The score of sympathetic symptoms before surgery, 2 months after surgery and at the final follow-up were 8.4±1.0,2.2±0.3,and 2.4±0.3, respectively. There were 22 excellent cases, 15 good cases, 1 fair case and 1 bad case in terms of RR. Good to excellent results were attained in 95% of theses patients. The sympathetic symptoms improved in all the patients and the score was significantly improved after surgery. There was one patient who had cerebral spinal fluid leakage but he recovered one week after surgery. Two patients felt a mild swallowing discomfort, but it disappeared within one month after surgery. Subcutaneous hematoma occurred in one patient due to obstructed drainage. It was cleared two days after surgery.
Cervical spondylosis patients with sympathetic symptoms may be managed successfully with ACDF using PEEK cages. Successful clinical results regarding symptom improvement and general satisfaction with the surgical procedure depend not only on obtaining successful decompression and radiographic fusion but also on patient selection.
探讨聚醚醚酮（PEEK）椎间融合器辅助下颈椎前路椎间盘切除融合术（ACDF）治疗交感型颈椎病的临床疗效。
对39例诊断为交感型颈椎病并接受PEEK椎间融合器ACDF手术的患者进行回顾性分析。评估术前、术后及末次随访时获得的X线片融合质量。采用以下标准评估融合的影像学成功：（1）终板消失，无透亮线；（2）骨小梁填充椎间隙；（3）屈伸位侧位X线片上手术节段棘突间椎间活动度小于2°或活动度小于2mm。术前、术后2个月及末次随访时，采用20分制对包括眩晕、头痛、耳鸣、恶心呕吐、心悸、记忆力减退及胃肠不适等交感症状进行评分。同时评估恢复率和临床满意率。还评估手术并发症。
至少随访1年，平均随访15.6个月。末次随访时颈椎X线片显示36例融合牢固，无假关节形成迹象。2例患者分别在9个月和11个月时延迟愈合并实现骨融合。1例发现假关节，但患者无症状。术前、术后2个月及末次随访时交感症状评分分别为8.4±1.0、2.2±0.3和2.4±0.3。恢复率方面，优22例，良15例，可1例，差1例。95%的患者获得了良好至优秀的结果。所有患者交感症状均有改善，术后评分显著提高。1例患者发生脑脊液漏，但术后1周恢复。2例患者有轻度吞咽不适，但术后1个月内消失。1例患者因引流不畅出现皮下血肿，术后2天清除。
使用PEEK椎间融合器的ACDF手术可成功治疗交感型颈椎病患者。关于症状改善和手术总体满意度的成功临床结果不仅取决于获得成功的减压和影像学融合，还取决于患者的选择。
