Theologou Marios, Theologou Theologos, Skoulios Nikolaos, Mitka Maria, Karanikolas Nikolaos, Theologou Antriana, Georgiou Eleftheria, Matejic Slavisa, Tsonidis Christos
Second Departments of Neurosurgery, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Greece.
Fifth Department of Surgery, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Greece.
Asian J Neurosurg. 2020 Aug 28;15(3):554-559. doi: 10.4103/ajns.AJNS_196_19. eCollection 2020 Jul-Sep.
Anterior cervical discectomy with fusion (ACDF) is a proven method for the treatment of selected patients. The necessity of use of an anterior plate is controversial. The article aims to assess the fusion rates (FRs) and long-term outcomes following three-level ACDF.
Data were collected from the medical records of patients operated on due to degenerative cervical disease. All patients were treated with three-level ACDF employing polyether ether-ketone cages without anterior plating. Visual analog scale (VAS), neck disability index (NDI), and plain radiographs were used in the clinical and radiological postsurgery assessment. Fusion evaluation was performed according to the <1 mm motion between spinous processes rule. Subsidence was defined as a more than 2 mm decrease in the interbody height.
A total of 234 treated levels on 78 patients were assessed. The mean presurgery NDI score was 23.07 ± 4.86, with a mean disability of 46.03% ± 9.64. The mean presurgery VAS score of the neck was 7.58 ± 0.85, while VAS score of the arm was 7.75 ± 1.008. Post surgery, NDI stated no disability, while VAS score of the neck and arm showed no presence of pain. The mean FR was 19.50 ± 21.71 levels per month, with a peak from 3 to 6 month. Presurgery evaluation showed 12 (15.38%) patients with a high T2 sequence signal. Magnetic resonance imaging screening detected 31 (39.24%) patients with coexisting cervical and lumbar findings. Post surgery, transient dysphagia was reported by 1 patient (1.28%), while subsidence was registered in 15 (6.41%) levels, situated in 12 patients (15.38%), most often at C (66.6%). Clinical and radiological follow-up extended to 69.47 ± 11.45 months.
Multilevel stand-alone ACDF is a safe, cost-effective procedure providing favorable clinical and radiological results with minimal complications. The incidence of subsidence is usually clinically insignificant and can be decreased with a careful surgical technique.
颈椎前路椎间盘切除融合术（ACDF）是治疗特定患者的一种经证实的方法。使用前路钢板的必要性存在争议。本文旨在评估三级ACDF后的融合率（FRs）和长期疗效。
从因退行性颈椎疾病接受手术的患者病历中收集数据。所有患者均接受三级ACDF治疗，采用聚醚醚酮椎间融合器，未使用前路钢板。临床和术后影像学评估采用视觉模拟量表（VAS）、颈部功能障碍指数（NDI）和平片。融合评估根据棘突间运动<1mm规则进行。下沉定义为椎间高度下降超过2mm。
共评估了78例患者的234个治疗节段。术前NDI评分平均为23.07±4.86，平均功能障碍为46.03%±9.64。术前颈部VAS评分平均为7.58±0.85，而手臂VAS评分为7.75±1.008。术后，NDI显示无功能障碍，而颈部和手臂的VAS评分显示无疼痛。平均融合率为每月19.50±21.71个节段，3至6个月时达到峰值。术前评估显示12例（15.38%）患者T2序列信号较高。磁共振成像筛查发现31例（39.24%）患者同时存在颈椎和腰椎病变。术后，1例患者（1.28%）报告有短暂吞咽困难，15个节段（6.41%）出现下沉，位于12例患者（15.38%）中，最常见于C节段（66.6%）。临床和影像学随访延长至69.47±11.45个月。
多级独立ACDF是一种安全、经济有效的手术方法，能提供良好的临床和影像学结果，并发症最少。下沉发生率通常在临床上无显著意义，可通过仔细的手术技术降低。
