Department of Spine Surgery, The First Hospital of Jilin University, Changchun City, PR China.
Department of Spine Surgery, The First Hospital of Jilin University, Changchun City, PR China.
World Neurosurg. 2020 Oct;142:e357-e363. doi: 10.1016/j.wneu.2020.06.236. Epub 2020 Jul 9.
OBJECTIVE: Inappropriate intervertebral height restoration caused by nonoptimal choice of cage size is common in anterior cervical discectomy and fusion. The purpose of this study was to evaluate the radiological and clinical outcomes of cervical intervertebral distraction performed in prediscectomy under the strain limitation of the intact disc in a procedure defined as disc-limited intervertebral distraction. METHODS: A total of 61 patients were enrolled. Japanese Orthopaedic Association score, Neck Disability Index, and visual analog scale score for neck pain were evaluated. The parameters of the degenerative intervertebral space height, mean value of the adjacent intervertebral space heights, preoperative and postoperative day 3 segmental height, regional sagittal alignment and global sagittal alignment were measured on plain radiographs. The change in the degenerative intervertebral space height, postoperative day 3 degenerative intervertebral space height, and intervertebral distraction ratio were calculated according to the parameters measured on radiographs. RESULTS: The change in the degenerative intervertebral space height and distraction ratio in the study group were both significantly lower than those in the control group (both P < 0.001). In the study group, there was no significant difference between postoperative day 3 degenerative intervertebral space height and mean value of the adjacent intervertebral space heights (P = 0.752). The Japanese Orthopaedic Association score improved significantly in both groups, with similar recovery rates. There were significant differences in neck pain score and Neck Disability Index between the groups at the 3 days and 1 month follow-ups (P < 0.001). CONCLUSIONS: Disc-limited intervertebral distraction is beneficial in avoiding overestimation of the cage size when performing anterior cervical discectomy and fusion and physiologically restoring intervertebral space height.
目的:由于椎间笼大小选择不当导致椎间高度恢复不当,在颈椎前路椎间盘切除融合术中较为常见。本研究旨在评估在椎间盘限制下的颈椎椎间分离术(disc-limited intervertebral distraction)中,在椎间盘完整的椎间盘应变限制下,于术前切除椎间盘时进行颈椎椎间分离的影像学和临床结果。
方法:共纳入 61 例患者。评估日本矫形协会评分(Japanese Orthopaedic Association score)、颈部残疾指数(Neck Disability Index)和颈部疼痛视觉模拟评分(visual analog scale score for neck pain)。在平片上测量退行性椎间空间高度、相邻椎间空间高度平均值、术前和术后第 3 天的节段高度、局部矢状面排列和整体矢状面排列的参数。根据影像学测量的参数计算退行性椎间空间高度的变化、术后第 3 天退行性椎间空间高度和椎间分离比。
结果:研究组退行性椎间空间高度的变化和分离比均明显低于对照组(均 P < 0.001)。在研究组中,术后第 3 天退行性椎间空间高度与相邻椎间空间高度平均值之间无显著差异(P = 0.752)。两组日本矫形协会评分均显著改善,恢复率相似。两组在术后第 3 天和 1 个月随访时的颈部疼痛评分和颈部残疾指数均有显著差异(P < 0.001)。
结论:椎间盘限制下的椎间分离术有利于避免在颈椎前路椎间盘切除融合术中高估椎间笼大小,并生理性地恢复椎间高度。
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