Oni Paul, Schultheiß Rolf, Scheufler Kai-Michael, Roberg Jakob, Harati Ali
Department of Neurosurgery, Klinikum Dortmund, 44145 Dortmund, Germany.
J Clin Med. 2018 Nov 23;7(12):469. doi: 10.3390/jcm7120469.
Multilevel anterior cervical decompression and fixation of four and more levels is a common surgical procedure used for several diseases.
We reviewed the radiological and clinical outcomes after anterior cervical discectomy or corpectomy and fixation of four and more levels in 85 patients (55 men and 30 women) with an average age of 59.6 years. Surgical indication was multilevel cervical degenerative myelopathy and radiculopathy in 72 (85%) patients, multilevel cervical spondylodiscitis in four (5%), complex traumatic cervical fractures in four (5%), metastatic cervical spine tumor in two (2%), and ossification of the posterior longitudinal ligament in three (3%) patients.
There were no severe intraoperative complications such as spinal cord or vertebral artery injury or dissection. Seventy-three patients had four, 10 patients had five, and two patients had six anterior cervical level fixations. The visual analog scale (VAS) and Japanese Orthopedic Association (mJOA) scale scores improved (6.9 to 1.3 ( < 0.001) and 13.9 to 16.5 ( < 0.001), respectively). The Cobb angle increased from 5.7° to 17.6° postoperatively ( < 0.001). Secondary posterior fixation was necessary in three cases due to pseudarthrosis.
The anterior approach appears to be optimal for ventral compressive pathology and lordosis restoration to the cervical spine. Limitations of multiple level decompression and fixation included increasing pseudoarthrosis rates, especially after corpectomy, and increasing fused level numbers.
四级及以上节段的多节段颈椎前路减压固定术是用于多种疾病的常见外科手术。
我们回顾了85例（55例男性和30例女性）平均年龄59.6岁患者在接受四级及以上节段颈椎前路椎间盘切除术或椎体次全切除并固定术后的影像学和临床结果。手术指征为72例（85%）患者的多节段颈椎退行性脊髓病和神经根病、4例（5%）患者的多节段颈椎化脓性脊柱炎、4例（5%）患者的复杂性创伤性颈椎骨折、2例（2%）患者的颈椎转移性肿瘤以及3例（3%）患者的后纵韧带骨化。
未发生诸如脊髓或椎动脉损伤或剥离等严重术中并发症。73例患者进行了四个节段的颈椎前路固定，10例患者进行了五个节段的固定，2例患者进行了六个节段的固定。视觉模拟量表（VAS）和日本骨科协会（mJOA）量表评分均有所改善（分别从6.9降至1.3（<0.001）和从13.9升至16.5（<0.001））。术后Cobb角从5.7°增加至17.6°（<0.001）。3例患者因假关节形成需要二期后路固定。
前路手术似乎是治疗颈椎前路压迫性病变和恢复颈椎前凸的最佳方法。多节段减压固定的局限性包括假关节形成率增加，尤其是椎体次全切除术后，以及融合节段数量增加。
