Laratta Joseph L, Reddy Hemant P, Bratcher Kelly R, McGraw Katlyn E, Carreon Leah Y, Owens R Kirk
Norton Leatherman Spine Center, Louisville, KY, USA.
Northeast Ohio Medical University, Rootstown, OH, USA.
J Spine Surg. 2018 Sep;4(3):496-500. doi: 10.21037/jss.2018.06.16.
Anterior cervical discectomy and fusion (ACDF) for cervical degenerative disease is an accepted treatment for symptomatic cervical radiculopathy and myelopathy. One- and two-level fusions are much more common and more widely studied. Outcomes and revision rates for three- and four-level ACDF have not been well described. The purpose of this study is to report on clinical outcomes and revision rates following multilevel ACDF.
Patients who underwent three- or four-level anterior cervical discectomy with plate fixation between 2006 and 2011 from a single-center multi-surgeon practice for symptomatic cervical degenerative disease were identified. Improvements in neck disability index (NDI), neck and arm pain scores two years after surgery and revision rates were analyzed.
Forty-six patients with a mean age of 55.9 years were included in the analysis. Twenty-one (46%) were male, 10 (22%) were smokers. Forty-one (89%) underwent three-level fusion and 5 (11%) underwent four-level fusion. NDI improved from 34.46 at baseline to 25.47 at 2 years. Neck pain improved from 7.04 at baseline to 3.95 and arm pain improved from 6.24 to 3.09 at 2 year follow up. Sixteen patients (35%) returned to surgery within 2 years with 11 of these patients (24%) returning for non-union. The average number of days to revision surgery was 750.6±570.3 days.
Patients undergoing three- and four-level ACDF for multilevel cervical disease demonstrate substantial improvement in outcomes. However, the two-year revision rate is relatively high at 35% with the majority of these patients returning due to non-union.
颈椎前路椎间盘切除融合术（ACDF）用于治疗颈椎退行性疾病，是治疗有症状的神经根型颈椎病和脊髓型颈椎病的一种公认疗法。单节段和双节段融合更为常见且研究更为广泛。三节段和四节段ACDF的疗效及翻修率尚未得到充分描述。本研究的目的是报告多节段ACDF后的临床疗效及翻修率。
确定2006年至2011年间在单中心多外科医生诊所因有症状的颈椎退行性疾病接受三节段或四节段颈椎前路椎间盘切除并钢板固定的患者。分析术后两年颈部功能障碍指数（NDI）、颈部和手臂疼痛评分的改善情况以及翻修率。
46例患者纳入分析，平均年龄55.9岁。21例（46%）为男性，10例（22%）为吸烟者。41例（89%）接受三节段融合，5例（11%）接受四节段融合。NDI从基线时的34.46改善至2年时的25.47。颈部疼痛从基线时的7.04改善至2年随访时的3.95，手臂疼痛从6.24改善至3.09。16例患者（35%）在2年内再次手术，其中11例患者（24%）因骨不连再次手术。翻修手术的平均天数为750.6±570.3天。
因多节段颈椎疾病接受三节段和四节段ACDF的患者疗效有显著改善。然而，两年翻修率相对较高，为35%，其中大多数患者因骨不连而再次手术。
