Bohlman H H, Emery S E, Goodfellow D B, Jones P K
Reconstructive and Traumatic Spine Surgery Center, University Hospitals of Cleveland.
J Bone Joint Surg Am. 1993 Sep;75(9):1298-307. doi: 10.2106/00004623-199309000-00005.
We evaluated the results of the Robinson method of anterior cervical discectomy and arthrodesis with use of autogenous iliac-crest bone graft, at one to four levels, in 122 patients who had cervical radiculopathy. A one-level procedure was done in sixty-two of the 122 patients; a two-level procedure, in forty-eight; a three-level procedure, in eleven; and a four-level procedure, in one. The average duration of clinical and roentgenographic follow-up was six years (range, two to fifteen years). The average age was fifty years (range, twenty-five to seventy-eight years). Preoperatively, 118 patients had pain in the arm, fifty-five had weakness of one or more motor roots, and seventy-seven had sensory loss. At the time of follow-up, eighty-one patients had no pain in the neck, twenty-six had mild pain in the neck, nine had moderate pain in the neck, four had mild radicular pain, and two had a combination of mild radicular pain and moderate pain in the neck. One hundred and eight patients had no functional impairment, and fourteen had a slight limitation of function during the activities of daily living. Nine of eleven patients who had symptoms related to a change at one level cephalad or caudad to the site of a previous arthrodesis had another operative procedure. Lateral roentgenograms of the cervical spine, made in flexion and extension, showed a pseudarthrosis at twenty-four of 195 operatively treated segments. Sixteen of the patients who had a pseudarthrosis were symptomatic, but only four had sufficient pain to warrant revision. The risk of pseudarthrosis was significantly greater after a multiple-level arthrodesis than after a single-level arthrodesis (p < 0.01). At the time of the most recent follow-up, fifty-three of the fifty-five patients who had had a motor deficit had had a complete recovery, and the two remaining patients had had a partial recovery. Seventy-one of the seventy-seven patients who had had a sensory loss had regained sensation. None of the patients had an increased neurological deficit postoperatively. Our results suggest that the Robinson anterior cervical discectomy and arthrodesis with an autogenous iliac-crest bone graft for cervical radiculopathy is a safe procedure that can relieve pain and lead to resolution of neurological deficits in a high percentage of patients.
我们评估了采用自体髂嵴骨移植的Robinson前路颈椎间盘切除及融合术治疗122例神经根型颈椎病患者的效果，手术节段为1至4个节段。122例患者中，62例行单节段手术；48例行双节段手术；11例行三节段手术；1例行四节段手术。临床及影像学随访的平均时间为6年（范围为2至15年）。平均年龄为50岁（范围为25至78岁）。术前，118例患者有手臂疼痛，55例有一个或多个运动神经根无力，77例有感觉丧失。随访时，81例患者颈部无疼痛，26例有颈部轻度疼痛，9例有颈部中度疼痛，4例有轻度神经根性疼痛，2例有轻度神经根性疼痛合并颈部中度疼痛。108例患者无功能障碍，14例在日常生活活动中有轻微功能受限。11例有症状与先前融合部位头侧或尾侧一个节段变化相关的患者中，9例接受了再次手术。颈椎屈伸位的侧位X线片显示，195个手术治疗节段中有24个出现假关节形成。16例出现假关节形成的患者有症状，但只有4例疼痛严重到需要翻修手术。多节段融合术后假关节形成的风险显著高于单节段融合术（p < 0.01）。在最近一次随访时，55例有运动功能缺损的患者中有53例完全恢复，其余2例部分恢复。77例有感觉丧失的患者中有71例恢复了感觉。所有患者术后均无神经功能缺损加重。我们的结果表明，采用自体髂嵴骨移植的Robinson前路颈椎间盘切除及融合术治疗神经根型颈椎病是一种安全的手术方法，可缓解疼痛，并使高比例患者的神经功能缺损得到改善。
