Liu Zhenlei, Wang Yaobin, Zhang Lei, Jia Shanhang, Wang He, Cheng Lei, Jian Fengzeng, Wang Kai, Wu Hao
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Spine Center, China International Neuroscience Institute (China-INI), Beijing, China.
Orthop Surg. 2025 Apr;17(4):1265-1274. doi: 10.1111/os.14366. Epub 2025 Jan 21.
Iatrogenic cervical kyphosis (ICK) often requires complex anterior and posterior correction, which is associated with multiple complications. Consequently, there is a need to investigate alternative treatment approaches that streamline the operative process and markedly diminish postoperative complications. This study, therefore, aimed to evaluate the feasibility and efficacy of a single-stage anterior controllable antedisplacement fusion (ACAF) in revision surgeries for ICK.
A retrospective review was conducted on three ICK cases treated with the ACAF technique in our department from December 2023 to January 2024. The cohort comprised two females and one male. The medical records, symptoms, signs, imaging studies, and 3-month postoperative follow-up data were analyzed to preliminarily evaluate the surgery's feasibility and efficacy.
The mean operative time was 222.0 ± 67.5 min, with an average blood loss of 83.3 ± 28.9 mL and an average hospital stay of 11.7 ± 2.9 days. No patient experienced severe complications, such as neurological damage, during surgery. Postoperatively, two patients experienced transient respiratory distress within 2-5 days, managed with low-dose methylprednisolone (80 mg daily) and supplemental oxygen via nasal cannula. At the 3-month follow-up, all patients showed significant symptom improvement and increased cervical Japanese Orthopedic Association scores. Radiographic assessments, including X-rays and computed tomography scans, demonstrated marked improvements in cervical curvature without evidence of screw loosening. Magnetic resonance imaging indicated significant dural sac expansion and alleviation of spinal cord compression.
The ACAF technique effectively corrects ICK, offering advantages such as reduced intraoperative blood loss, fewer complications, and shorter operative and hospitalization times compared to traditional combined anterior-posterior corrective approaches. It presents an effective alternative for surgeons performing revision corrective surgery for ICK.
医源性颈椎后凸（ICK）通常需要复杂的前后路矫正，这会带来多种并发症。因此，有必要研究能简化手术过程并显著减少术后并发症的替代治疗方法。本研究旨在评估单阶段前路可控前移融合术（ACAF）在ICK翻修手术中的可行性和疗效。
对2023年12月至2024年1月在我科采用ACAF技术治疗的3例ICK病例进行回顾性分析。该队列包括2名女性和1名男性。分析病历、症状、体征、影像学检查及术后3个月的随访数据，以初步评估手术的可行性和疗效。
平均手术时间为222.0±67.5分钟，平均失血量为83.3±28.9毫升，平均住院时间为11.7±2.9天。术中无患者出现严重并发症，如神经损伤。术后，2例患者在2 - 5天内出现短暂呼吸窘迫，通过低剂量甲基强的松龙（每日80毫克）和鼻导管吸氧治疗。在3个月的随访中，所有患者症状均有明显改善，颈椎日本骨科协会评分提高。包括X线和计算机断层扫描在内的影像学评估显示颈椎曲度有明显改善，无螺钉松动迹象。磁共振成像显示硬脊膜囊明显扩张，脊髓压迫减轻。
与传统的前后联合矫正方法相比，ACAF技术能有效矫正ICK，具有术中失血量减少、并发症少、手术和住院时间短等优点。它为进行ICK翻修矫正手术的外科医生提供了一种有效的替代方法。
