UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Italy.
UOC di Neurochirurgia, Azienda Ospedaliera Sant'Anna, Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy.
J Neurol Surg A Cent Eur Neurosurg. 2021 Nov;82(6):556-561. doi: 10.1055/s-0041-1726112. Epub 2021 May 19.
Anterior cervical diskectomy and fusion (ACDF) has been providing good surgical, clinical, and radiologic outcomes in patients suffering from cervical degenerative disk disease (DDD). However, the role of anterior plating is still debated, especially in three-level procedures. This study aimed to investigate long-term clinical and radiologic outcomes and complications after three-level contiguous ACDF without plating for cervical DDD.
Two institutional databases were retrieved (January 2009-December 2014) for patients treated with three-level contiguous ACDF without plating. Minimum follow-up (FU) was 5 years. Demographical data, smoking status, implant types, Neck Disability Index (NDI), visual analog scale (VAS) for neck pain, complications, fusion rate, adjacent segment degeneration (ASD), cervical lordosis (CL), and residual segmental mobility were evaluated.
We enrolled 21 patients. Tantalum and carbon fiber cages were implanted, respectively, in 13 and 8 patients. The mean FU length was 5.76 ± 0.87 years. Mean NDI score was 78.29 ± 9.98% preoperatively and 8.29 ± 1.67% at last FU ( < 0.01), whereas mean VAS score decreased from 7.43 ± 1.14 preoperatively to 0.95 ± 0.95 at last FU ( < 0.01). Complications were one postoperative hematoma, one superficial wound infection, and five cases of postoperative dysphagia (recovered within 3 days). The fusion rate was 90% and ASD was reported in three (14%) cases. The mean CL was 6.33 ± 2.70 degrees preoperatively, 8.19 ± 1.97 degrees 3 months after surgery ( = 0.02), and 7.62 ± 1.96 degrees at latest FU. There was no residual mobility on every operated segment at last FU. The smoking status was an independent risk factor for nonfusion in this case series ( = 0.02).
Three-level contiguous ACDF without plating seems to be an effective treatment for cervical DDD. Properly designed comparative clinical trials are needed to further investigate this topic.
颈椎前路减压融合术（ACDF）为患有颈椎退行性椎间盘疾病（DDD）的患者提供了良好的手术、临床和影像学结果。然而，前路钢板的作用仍存在争议，尤其是在三平面手术中。本研究旨在探讨三平面连续颈椎前路减压融合术（ACDF）不使用钢板治疗颈椎 DDD 的长期临床和影像学结果及并发症。
从两个机构数据库中检索（2009 年 1 月至 2014 年 12 月）接受三平面连续颈椎前路减压融合术（ACDF）不使用钢板治疗的患者。最低随访时间为 5 年。评估患者的人口统计学数据、吸烟状况、植入物类型、颈痛残疾指数（NDI）、颈部视觉模拟评分（VAS）、并发症、融合率、相邻节段退变（ASD）、颈椎前凸角（CL）和残留节段活动度。
共纳入 21 例患者，分别植入钽和碳纤维椎间融合器。平均随访时间为 5.76±0.87 年。术前 NDI 评分为 78.29±9.98%，末次随访时为 8.29±1.67%（ < 0.01），术前 VAS 评分为 7.43±1.14，末次随访时为 0.95±0.95（ < 0.01）。术后并发症包括 1 例血肿，1 例浅表伤口感染，5 例术后吞咽困难（均在 3 天内恢复）。融合率为 90%，3 例（14%）发生 ASD。术前 CL 平均为 6.33±2.70 度，术后 3 个月为 8.19±1.97 度（ = 0.02），末次随访时为 7.62±1.96 度。末次随访时，各手术节段均无残留活动度。吸烟状态是该病例系列中不融合的独立危险因素（ = 0.02）。
三平面连续颈椎前路减压融合术（ACDF）不使用钢板似乎是治疗颈椎 DDD 的有效方法。需要进行适当设计的临床对照试验来进一步研究这一课题。
