Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, CH-8008, Switzerland.
Balgrist University Hospital, University Spine Center Zurich, University of Zurich, Zurich, Switzerland.
BMC Musculoskelet Disord. 2023 Aug 29;24(1):688. doi: 10.1186/s12891-023-06819-7.
BACKGROUND: Pseudoarthrosis after anterior cervical discectomy and fusion (ACDF) is relatively common and can result in revision surgery. The aim of the study was to analyze the outcome of patients who underwent anterior revision surgery for pseudoarthrosis after ACDF. METHODS: From 99 patients with cervical revision surgery, ten patients (median age: 48, range 37-74; female: 5, male: 5) who underwent anterior revision surgery for pseudoarthrosis after ACDF with a minimal follow up of one year were included in the study. Microbiological investigations were performed in all patients. Computed tomography (CT) scans were used to evaluate the radiological success of revision surgery one year postoperatively. Clinical outcome was quantified with the Neck Disability Index (NDI), the Visual Analog Scale (VAS) for neck and arm pain, and the North American Spine Society Patient Satisfaction Scale (NASS) 12 months (12-60) after index ACDF surgery. The achievement of the minimum clinically important difference (MCID) one year postoperatively was documented. RESULTS: Occult infection was present in 40% of patients. Fusion was achieved in 80%. The median NDI was the same one year postoperatively as preoperatively (median 23.5 (range 5-41) versus 23.5 (7-40)), respectively. The MCID for the NDI was achieved 30%. VAS-neck pain was reduced by a median of 1.5 points one year postoperatively from 8 (3-8) to 6.5 (1-8); the MCID for VAS-neck pain was achieved in only 10%. Median VAS-arm pain increased slightly to 3.5 (0-8) one year postoperatively compared with the preoperative value of 1 (0-6); the MCID for VAS-arm pain was achieved in 14%. The NASS patient satisfaction scale could identify 20% of responders, all other patients failed to reach the expected benefit from anterior ACDF revision surgery. 60% of patients would undergo the revision surgery again in retrospect. CONCLUSION: Occult infections occur in 40% of patients who undergo anterior revision surgery for ACDF pseudoarthrosis. Albeit in a small cohort of patients, this study shows that anterior revision surgery may not result in relevant clinical improvements for patients, despite achieving fusion in 80% of cases. LEVEL OF EVIDENCE: Retrospective study, level III.
背景：颈椎前路椎间盘切除融合术后（ACDF）的假关节较为常见，可能需要进行翻修手术。本研究旨在分析接受颈椎前路翻修手术治疗 ACDF 后假关节的患者的治疗效果。
方法：从 99 例颈椎翻修手术患者中，选择了 10 例（中位年龄：48 岁，范围 37-74 岁；女性：5 例，男性：5 例）接受颈椎前路翻修手术治疗 ACDF 后假关节的患者进行研究，这些患者的随访时间均至少为 1 年。所有患者均进行了微生物学检查。术后 1 年，通过计算机断层扫描（CT）评估翻修手术的影像学效果。使用颈椎残障指数（NDI）、颈部和手臂疼痛的视觉模拟量表（VAS）以及北美脊柱协会患者满意度量表（NASS）来量化临床疗效，在接受 ACDF 手术 12 个月（12-60 个月）后进行评估。记录术后 1 年时达到最小临床重要差异（MCID）的情况。
结果：40%的患者存在隐匿性感染。80%的患者融合成功。术后 1 年时，NDI 的中位数与术前相同（分别为 23.5（范围 5-41）和 23.5（7-40））。NDI 的 MCID 为 30%。术后 1 年时，VAS 颈痛中位数降低了 1.5 分，从 8（3-8）降至 6.5（1-8）；但 VAS 颈痛的 MCID 仅达到 10%。术后 1 年时，VAS 手臂痛中位数略有增加至 3.5（0-8），与术前的 1（0-6）相比；但 VAS 手臂痛的 MCID 仅达到 14%。北美脊柱协会患者满意度量表可识别出 20%的应答者，其余所有患者均未从颈椎前路 ACDF 翻修手术中获得预期的获益。60%的患者回顾性表示会再次进行翻修手术。
结论：颈椎前路翻修手术治疗 ACDF 后假关节的患者中，隐匿性感染的发生率为 40%。尽管在一个小的患者队列中，本研究表明，尽管 80%的病例融合成功，但前路翻修手术可能不会为患者带来显著的临床改善。
证据等级：回顾性研究，III 级。
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