Lee Christopher J, Boody Barrett S, Demeter Jaclyn, Smucker Joseph D, Sasso Rick C
Indiana Spine Group, Carmel, IN, USA.
Global Spine J. 2020 Sep;10(6):741-747. doi: 10.1177/2192568219874768. Epub 2019 Sep 16.
Retrospective radiographic investigation.
To evaluate the long-term radiographic and functional outcomes of patients in whom there is absence of radiographic union at 2 years after single-level anterior cervical discectomy and fusion (ACDF).
Thirty-one patients were evaluated at standard postoperative time intervals per index trial protocol. Plain film radiographic fusion criteria at the arthrodesis level was defined as interspinous motion (ISM) <1 mm with corresponding motion at a non-arthrodesed superjacent level ISM ≥4 mm. Radiographs and functional outcome measures were acquired at each follow-up visit. Delayed union was defined as lack of radiographic union by 24 months.
Nine patients demonstrated radiographic evidence of delayed radiographic union at 24 months. Of those 9 patients, 5 patients demonstrated evidence of union during the follow-up period to 72 months. Despite the absence of radiographic union based on our criteria, 3 of the 4 remaining patients reported remarkable improvements in pain scores and functional outcomes.
The natural history of delayed union at 24 months after ACDF was still favorable despite the prolonged delay in union. The majority of patients (5 of 9) without radiographic union at 24 months did proceed to radiographic union by final follow-up. In addition, patients that did not meet our criteria for fusion maintained postoperative improvements in patient-reported outcome scores. In summary, our study patients undergoing a single-level ACDF with asymptomatic radiographic delayed union at 24 months can expect maintained improvements in postoperative patient-reported outcomes scores and can still progress to successful radiographic fusion.
回顾性影像学调查。
评估单节段颈椎前路椎间盘切除融合术（ACDF）后2年仍无影像学融合的患者的长期影像学和功能结局。
根据每项指标试验方案，在标准术后时间间隔对31例患者进行评估。关节融合水平的平片影像学融合标准定义为棘突间运动（ISM）<1mm，且相邻未融合节段的相应运动ISM≥4mm。每次随访时均获取X线片和功能结局指标。延迟融合定义为24个月时无影像学融合。
9例患者在24个月时显示有延迟影像学融合的影像学证据。在这9例患者中，5例在随访至72个月期间显示有融合证据。尽管根据我们的标准没有影像学融合，但其余4例患者中有3例报告疼痛评分和功能结局有显著改善。
尽管融合延迟延长，但ACDF术后24个月延迟融合的自然病程仍然良好。大多数在24个月时无影像学融合的患者（9例中的5例）在最终随访时实现了影像学融合。此外，不符合我们融合标准的患者术后患者报告结局评分仍有改善。总之，我们的研究表明，接受单节段ACDF且在24个月时有无症状影像学延迟融合的患者，术后患者报告结局评分有望持续改善，并且仍可成功实现影像学融合。
