Department of Neurosurgery, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2021 Mar;62(3):240-248. doi: 10.3349/ymj.2021.62.3.240.
This study aimed to present our experience with failures in C-TDR and revision surgery outcomes.
We retrospectively examined patients who underwent revision surgery due to the failure of C-TDR between May 2005 to March 2019. Thirteen patients (8 males and 5 females) were included in this study. The mean age was 46.1 years (range: 22-61 years), and the average follow-up period was 19.5 months (range: 12-64 months). The outcome measures of pre- and post-operative neck and arm pain using a visual analogue scale (VAS) and functional impairment were assessed using a modified Japanese Orthopedic Association (JOA) scale and the Neck Disability Index (NDI).
The main complaints of patients were posterior neck pain (77%), radiculopathy (62%), and/or myelopathy (62%). The causes of failure of C-TDR were improper indications for the procedure, osteolysis and mobile implant use, inappropriate techniques, and postoperative infection. The most common surgical level was C5-6, followed by C4-5. After revision surgery, the neck and arm pain VAS (preoperative vs. postoperative: 5.46 vs. 1.31; 4.86 vs. 1.08), a modified JOA scale (14.46 vs. 16.69), and the NDI (29.77 vs. 9.31) scores were much improved.
C-TDR is good surgical option. However, it is very important to adhere to strict surgical indications and contraindications to avoid failure of C-TDR. The results of reoperations were good regardless of the approach. Therefore, various reoperation options could be considered in patients with failed C-TDR.
本研究旨在介绍我们在 C-TDR 失败和翻修手术结果方面的经验。
我们回顾性研究了 2005 年 5 月至 2019 年 3 月期间因 C-TDR 失败而接受翻修手术的患者。本研究纳入了 13 名患者（8 名男性和 5 名女性）。平均年龄为 46.1 岁（范围：22-61 岁），平均随访时间为 19.5 个月（范围：12-64 个月）。使用视觉模拟量表（VAS）评估术前和术后颈部和手臂疼痛，使用改良日本骨科协会（JOA）量表和颈部残疾指数（NDI）评估功能障碍。
患者的主要症状为颈后疼痛（77%）、神经根病（62%）和/或颈椎病（62%）。C-TDR 失败的原因包括手术适应证不当、骨溶解和活动植入物的使用、不当的技术以及术后感染。最常见的手术节段是 C5-6，其次是 C4-5。翻修手术后，颈部和手臂疼痛 VAS（术前 vs. 术后：5.46 vs. 1.31；4.86 vs. 1.08）、改良 JOA 量表（14.46 vs. 16.69）和 NDI（29.77 vs. 9.31）评分均明显改善。
C-TDR 是一种较好的手术选择。然而，严格遵守手术适应证和禁忌证非常重要，以避免 C-TDR 失败。无论采用何种手术入路，翻修手术的结果都很好。因此，对于 C-TDR 失败的患者，可以考虑各种翻修手术选择。
