Yu Rongguo, Yuan Xiurong, Huang Kangkang, Wu Tingkui, Wang Hong, Ding Chen, Wang Beiyu, Liu Hao
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
West China School of Nursing, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, P.R. China.
J Orthop Surg Res. 2024 Dec 31;19(1):896. doi: 10.1186/s13018-024-05339-x.
Anterior cervical corpectomy and fusion (ACCF) is a standard surgical procedure for cervical spondylosis with spinal cord compression (CSWSCC), especially in patients with intensity on T2-weighted imaging high signal (T2WIHS). The titanium mesh cage (TMC) utilized in this procedure is essential in stabilizing the spine; however, the optimal slotting width of the TMC remains unclear.
This study aimed to investigate the impact of TMC slotting width on the clinical and radiological outcomes of ACCF in patients with spinal cord compression type cervical spondylosis with intensity on T2WIHS (CST2WIHS).
We retrospectively analyzed 69 patients who underwent single-level ACCF between December 2010 and October 2021. The patients were divided into narrower (< 2 mm) and wider (> 2 mm) groups based on the slotting width of the TMC. The Neck Disability Index (NDI) and Japanese Orthopedic Association (JOA) scores were used to assess clinical outcomes. Radiological outcomes included cervical lordosis (CL), functional spinal unit (FSU) height, transverse decompression range (TDR), spinal canal area (SCA), TMC alignment, and subsidence and fusion rates.
Patients in both groups exhibited significant postoperative improvement in NDI and JOA scores (P < 0.05). Radiologically, patients in the wider slotting group exhibited better decompression, evidenced by a larger TDR (P < 0.01) and smaller postoperative SCA (P < 0.01) than the narrow group. Regarding CL, FSU height, TMC alignment, subsidence, or fusion rates, the groups did not differ significantly. Although statistically non-significant, patients in the wider group exhibited a trend towards improvement in spinal cord signal intensity than those in the narrower group.
The study demonstrated that a wider TMC slotting width offers superior decompression and may improve postoperative spinal cord signal; it does not compromise spinal stability or fusion outcomes. These findings indicate that slotting width should be carefully considered in ACCF procedures to optimize decompression and spinal cord recovery.
颈椎前路椎体次全切除融合术（ACCF）是治疗伴有脊髓压迫的颈椎病（CSWSCC）的标准手术方法，尤其是对于T2加权成像高信号（T2WIHS）的患者。该手术中使用的钛网笼（TMC）对稳定脊柱至关重要；然而，TMC的最佳开槽宽度仍不清楚。
本研究旨在探讨TMC开槽宽度对脊髓压迫型伴T2WIHS的颈椎病（CST2WIHS）患者ACCF临床和影像学结果的影响。
我们回顾性分析了2010年12月至2021年10月期间接受单节段ACCF的69例患者。根据TMC的开槽宽度，将患者分为较窄（<2mm）组和较宽（>2mm）组。采用颈部功能障碍指数（NDI）和日本骨科协会（JOA）评分评估临床结果。影像学结果包括颈椎前凸（CL）、功能脊柱单元（FSU）高度、横向减压范围（TDR）、椎管面积（SCA）、TMC对线以及沉降和融合率。
两组患者术后NDI和JOA评分均有显著改善（P<0.05）。在影像学上，较宽开槽组患者的减压效果更好，表现为TDR更大（P<0.01），术后SCA更小（P<0.01），优于较窄组。关于CL、FSU高度、TMC对线、沉降或融合率，两组之间无显著差异。虽然无统计学意义，但较宽组患者的脊髓信号强度有优于较窄组的改善趋势。
该研究表明，较宽的TMC开槽宽度可提供更好的减压效果，并可能改善术后脊髓信号；它不会影响脊柱稳定性或融合结果。这些发现表明，在ACCF手术中应仔细考虑开槽宽度，以优化减压和脊髓恢复。
