Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.
Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.
Eur Spine J. 2023 May;32(5):1644-1654. doi: 10.1007/s00586-023-07648-x. Epub 2023 Mar 28.
To evaluate the clinical and radiological results of the operative management of three-column uncomplicated type «B» subaxial injures treated with a one-level cervical corpectomy with an expandable cage.
This study included 72 patients with a three-column uncomplicated type «B» subaxial injures who met the inclusion criteria, underwent a one-level cervical corpectomy with an expandable cage at one of three neurosurgical departments between 2005 and 2020, and were followed up for clinical and radiological outcomes at a minimum 3-yr follow-up.
There was a decrease in the VAS pain score from an average of 80 mm to 7 mm (p = 0.03); a decrease in the average NDI score from 62 to 14% (p = 0.01); excellent and good outcomes according to Macnab's scale were 93% (n = 67/72). There was an average change in the cervical lordosis (Cobb method) from -9.10 to -15.40 (p = 0.007), without significant loss of lordosis (p = 0.27). There was no significant degeneration of the adjacent levels by 3 years post-op. The fusion rate, using the Cervical Spine Research Society criteria, was poor: it was 62.5% (n = 45/72), and using the CT criteria, it was 65.3% (n = 47/72). 15.4% patients (n = 11/72) suffered complications. Statistical difference between the fusion and pseudoarthrosis (according to X-ray criteria) subgroups showed that there were no statistically significant differences in the smoking status, diabetes, chronic steroid use, cervical injury level, subtypes of AO type B subaxial injuries and types of expandable cage systems.
One-level cervical corpectomy with an expandable cage, despite a poor fusion rate, can be considered a feasible and relatively safe method for treating three-column uncomplicated subaxial type «B» injures, with the benefit of immediate stability, anatomical reduction, and direct decompression of the spinal cord. While no one in our series had any catastrophic complications, we did note a high complication rate.
评估采用单节段颈椎前路椎体次全切除并使用可扩张 cage 治疗三柱无合并损伤型 B 型下颈椎损伤的临床和影像学结果。
本研究纳入了 2005 年至 2020 年期间在三个神经外科部门接受单节段颈椎前路椎体次全切除并使用可扩张 cage 治疗的符合纳入标准的 72 例三柱无合并损伤型 B 型下颈椎损伤患者，随访至少 3 年以评估临床和影像学结果。
疼痛视觉模拟评分（VAS）从平均 80mm 降至 7mm（p=0.03），神经功能缺损指数（NDI）评分从平均 62%降至 14%（p=0.01），Macnab 量表评估的优、良率为 93%（72 例中有 67 例）。颈椎前凸角（Cobb 法）平均从-9.10°变为-15.40°（p=0.007），但无明显前凸丢失（p=0.27）。术后 3 年，无明显相邻节段退变。根据颈椎研究学会（Cervical Spine Research Society，CSRS）标准，融合率较差，为 62.5%（45/72），根据 CT 标准，融合率为 65.3%（47/72）。15.4%的患者（n=11/72）发生并发症。融合与假关节（根据 X 线标准）亚组的统计学差异表明，吸烟状况、糖尿病、慢性类固醇使用、颈椎损伤水平、AO 型 B 型下颈椎损伤亚型和可扩张 cage 系统类型之间无统计学差异。
尽管融合率较低，但单节段颈椎前路椎体次全切除并使用可扩张 cage 仍可被视为治疗三柱无合并损伤型 B 型下颈椎损伤的一种可行且相对安全的方法，其优点为即刻稳定性、解剖复位和脊髓直接减压。尽管我们的研究中没有患者出现灾难性并发症，但并发症发生率较高。
