Departments of Neurosurgery.
Radiology, University of Kansas Medical Center, Kansas City, KS.
Clin Spine Surg. 2021 May 1;34(4):E243-E247. doi: 10.1097/BSD.0000000000001116.
A retrospective review of prospectively collected case series.
This is a retrospective review of prospectively collected data regarding the clinical outcomes, complications, and fusion rates of patients who underwent a 4-level (C3-C7) anterior cervical discectomy and fusion (ACDF).
The use of multilevel ACDF for cervical spondylosis has been controversial. The literature regarding fusion rates and outcomes have been variable. This study intends to evaluate the outcomes following multilevel ACDF in a large cohort of patients.
Between 1994 and 2011, 60 patients underwent a 4-level ACDF by a single surgeon. All patients were followed for a minimum of 12 months, and outcome measures included neurological findings, presence or absence of radiographic fusion, and complication rates. All patients had radiographic documentation of spinal cord stenosis at 4 consecutive cervical levels as well as myelopathy and/or radiculopathy symptoms.
Forty-eight patients underwent a single anterior procedure, only 5 patients underwent concurrent anterior and posterior fusion, and 7 patients required a second posterior surgery due to new-onset or residual symptoms or hardware complications after undergoing ACDF. Patients most commonly presented with paresthesias and were diagnosed with cervical stenosis. Overall, 18.3% reported early postoperative dysphagia; however, only 2 patients continued to have mild dysphagia symptoms on long-term follow-up. Other complications included hardware failure (11), residual neck pain (7), residual paresthesias (6), new-onset weakness (3), neck hematoma (1), cellulitis (1), and C5 radiculopathy (1). Overall, 88.3% of patients reported improvement in initial symptoms. Nurick scores were significantly lower following 4-level ACDF. The radiographic fusion rate for all levels was 95%. No patients required reoperation for pseudarthrosis.
In appropriate patients, 4-level ACDF is a safe, efficacious method for treating multilevel cervical spinal cord compression, with acceptable complication rates and the ability to achieve neurological improvement and high fusion rates.
前瞻性收集病例系列的回顾性研究。
这是对前瞻性收集的关于行 4 节段（C3-C7）前路颈椎间盘切除融合术（ACDF）的患者的临床结果、并发症和融合率数据的回顾性分析。
对于颈椎病，使用多节段 ACDF 一直存在争议。关于融合率和结果的文献报道结果不一。本研究旨在评估大量患者接受多节段 ACDF 的结果。
1994 年至 2011 年期间，由一名外科医生对 60 例患者施行 4 节段 ACDF。所有患者的随访时间均至少为 12 个月，观察指标包括神经学发现、影像学融合的存在或缺失以及并发症发生率。所有患者均有 4 个连续颈椎水平脊髓狭窄的影像学资料以及颈椎病和/或神经根病的症状。
48 例患者接受了单一前路手术，仅 5 例患者同时接受了前路和后路融合，7 例患者因 ACDF 后新发或残留症状或内固定并发症需要再次行后路手术。患者最常见的表现为感觉异常，被诊断为颈椎狭窄。总体而言，18.3%的患者报告术后早期吞咽困难；然而，仅 2 例患者在长期随访中仍有轻度吞咽困难症状。其他并发症包括内固定失败（11 例）、残余颈痛（7 例）、残余感觉异常（6 例）、新发无力（3 例）、颈部血肿（1 例）、蜂窝织炎（1 例）和 C5 神经根病（1 例）。总体而言，88.3%的患者报告初始症状改善。Nurick 评分在接受 4 节段 ACDF 后显著降低。所有节段的影像学融合率为 95%。无患者因假关节形成而行再次手术。
在合适的患者中，4 节段 ACDF 是治疗多节段颈脊髓压迫的一种安全、有效的方法，并发症发生率可接受，能够实现神经学改善和高融合率。
