Lee Dong-Ho, Park Sehan, Seok Sang Yun, Cho Jae Hwan, Hwang Chang Ju, Kim In Hee, Baek Seung Hyun
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Daejeon Eulji Medical Center, University of Eulji College of Medicine, Daejeon, Korea.
Spine J. 2023 Dec;23(12):1790-1798. doi: 10.1016/j.spinee.2023.07.016. Epub 2023 Jul 22.
Prior study has shown that 70% of cervical pseudarthrosis after anterior cervical discectomy and fusion (ACDF) detected at 1 year will go on to fusion by 2 year. Pseudarthrosis detected 2 years after ACDF may have different bone healing potential compared to nonunion detected 1 year after surgery. Therefore, it might have a different clinical significance.
To examine the radiographic and clinical prognosis of pseudarthrosis detected 2 years after ACDF with a minimum follow-up of 5 years.
STUDY DESIGN/SETTING: Retrospective cohort study.
A total of 249 patients who completed a 5-year follow-up after ACDF.
Clinical outcomes such as neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDI) and radiographic assessment such as X-ray, computed tomography (CT) scan.
A total of 249 patients who completed a 5-year follow-up after ACDF were retrospectively reviewed. Patients who were diagnosed with pseudarthrosis at 2 years postoperatively were included. Fusion, neck pain VAS, arm pain VAS, and NDI were assessed. The results were compared between the union group (patients who achieved union), and the nonunion group (patients with pseudarthrosis) at 5 years postoperatively.
Among the patients who had pseudarthrosis at 2 years postoperatively, the fusion rate at 5 years was 32.6% (14/43). While the union group showed continued improvements in neck pain VAS, arm pain VAS, and NDI until 5 years, the nonunion group showed significant worsening of arm pain VAS and NDI at 5 years, with the values of neck pain VAS, arm pain VAS, and NDI being significantly worse than those of the union group at 5 years.
The incidence of pseudarthrosis detected at 2 years postoperatively after ACDF was 67.4%, and it remained unfused at 5 years postoperatively. Nonunion identified 2 years after ACDF may be considered a poor prognostic factor because it has less potential to achieve fusion with further follow-up and a higher chance of worsening clinical symptoms. Therefore, the presence of fusion at the 2-year follow-up can be considered an indicator of the success of the surgery.
先前的研究表明，在颈椎前路椎间盘切除融合术（ACDF）后1年检测到的颈椎假关节中，70%在2年时会实现融合。与术后1年检测到的骨不连相比，ACDF术后2年检测到的假关节可能具有不同的骨愈合潜力。因此，其可能具有不同的临床意义。
研究ACDF术后2年检测到的假关节的影像学和临床预后，随访时间至少为5年。
研究设计/地点：回顾性队列研究。
共有249例患者在ACDF术后完成了5年随访。
临床结局，如颈部疼痛视觉模拟量表（VAS）、手臂疼痛VAS和颈部功能障碍指数（NDI）；影像学评估，如X线、计算机断层扫描（CT）。
对249例在ACDF术后完成5年随访的患者进行回顾性分析。纳入术后2年被诊断为假关节的患者。评估融合情况、颈部疼痛VAS、手臂疼痛VAS和NDI。比较术后5年时融合组（实现融合的患者）和未融合组（假关节患者）的结果。
在术后2年有假关节的患者中，5年时的融合率为32.6%（14/43）。虽然融合组在5年时颈部疼痛VAS、手臂疼痛VAS和NDI持续改善，但未融合组在5年时手臂疼痛VAS和NDI显著恶化，其颈部疼痛VAS、手臂疼痛VAS和NDI的值在5年时显著差于融合组。
ACDF术后2年检测到的假关节发生率为67.4%，术后5年仍未融合。ACDF术后2年发现的骨不连可能被视为不良预后因素，因为其进一步随访实现融合的潜力较小，临床症状恶化的可能性较高。因此，2年随访时的融合情况可被视为手术成功的指标。
