Lanman Todd H, CuÉllar Jason M
University of California, Los Angeles, Department of Neurosurgery, Los Angeles, California.
Cedars-Sinai Medical Center, Department of Neurosurgery, Los Angeles, California.
Int J Spine Surg. 2020 Aug;14(4):483-487. doi: 10.14444/7063. Epub 2020 Jul 31.
Describe the technique and outcomes of the conversion of prior anterior cervical discectomy and fusion (ACDF) with pseudarthrosis to an artificial disc replacement (ADR).
Case report. Five patients completed the following pain and function questionnaires at baseline and postoperatively: visual analog pain scale (VAS), Neck Disability Index (NDI), PROMIS Emotional Distress-Depression Short Form-4a (P-EDD), PROMIS Pain Interference Short Form 6b (P-PI), and PROMIS Physical Function Short Form-10a (P-SF). Pseudarthrosis was diagnosed using computed tomography imaging of the cervical spine. The level of prior fusion with pseudarthrosis was remobilized after a standard anterior approach was made, and an artificial disc replacement was performed after revision discectomy.
The conversion of fusion to ADR was successful in all 5 patients without intraoperative or postoperative complication or the need to perform revision fusion. The average follow-up duration was 12.4 months (range 6-24months). VAS improved on average (median) from 6 (6.0) to 2 (2.2), NDI improved from 23 (21) to 15 (17), P-EDD 4a improved from 11 (11) to 4 (4), and P-PI and P-SF improved from 23 (22) to 16 (19) and from 37 (35) to 41 (39.5), respectively. Radiographic range of motion increased at the fusion conversion level from an average of 1° ± 1.2° to 8.1° ± 4.6° after the insertion of the artificial disc replacement.
The reversal of ACDF and conversion to an artificial disc replacement is feasible and achieves postoperative range of motion that is similar to that achieved when performed in a segment not previously fused.
描述既往前路颈椎间盘切除融合术（ACDF）假关节形成后转换为人工椎间盘置换术（ADR）的技术及结果。
病例报告。5例患者在基线期和术后完成了以下疼痛和功能问卷：视觉模拟疼痛量表（VAS）、颈部功能障碍指数（NDI）、患者报告结果测量信息系统情绪困扰 - 抑郁简表4a（P - EDD）、患者报告结果测量信息系统疼痛干扰简表6b（P - PI）以及患者报告结果测量信息系统身体功能简表10a（P - SF）。使用颈椎计算机断层扫描成像诊断假关节形成。在采用标准前路入路后，对既往存在假关节形成的融合节段进行松动，在翻修椎间盘切除术后进行人工椎间盘置换。
5例患者均成功将融合转换为ADR，无术中或术后并发症，也无需进行翻修融合。平均随访时间为12.4个月（范围6 - 24个月）。VAS平均（中位数）从6（6.0）改善至2（2.2），NDI从23（21）改善至15（17），P - EDD 4a从11（11）改善至4（4），P - PI和P - SF分别从23（22）改善至16（19）以及从37（35）改善至41（39.5）。人工椎间盘置换术后，融合转换节段的影像学活动度从平均1°±1.2°增加至8.1°±4.6°。
ACDF逆转并转换为人工椎间盘置换术是可行的，术后活动度与在未先前融合节段进行手术时相似。
