Phillips F M, Carlson G, Emery S E, Bohlman H H
University of Chicago Spine Center, Section of Orthopaedic Surgery, Illinois, USA.
Spine (Phila Pa 1976). 1997 Jul 15;22(14):1585-9. doi: 10.1097/00007632-199707150-00012.
A retrospective study of long-term clinical outcomes in 48 patients with pseudarthroses after anterior cervical discectomy and fusion.
To determine the natural history, risk factors, and treatment outcomes in a large population with documented pseudarthrosis after anterior cervical discectomy and fusion.
Recent reports suggest that pseudarthrosis after anterior cervical discectomy and fusion adversely affects clinical outcome. Little data regarding cervical pseudarthroses have been published, and conclusions have been drawn from reports with small patient populations and short-term follow-up periods.
Forty-eight patients with radiographically documented pseudarthrosis after anterior cervical discectomy and fusion were studied. Patients were examined and radiographs made at regular intervals (mean follow-up, 66 months). Clinical results were based on patients' assessment of pain, prescription drug use, activity level and Odom's criteria. Clinical outcomes in patients who underwent surgical repair of the pseudarthrosis are reported.
Of the 48 patients, 32 (67%) with pseudarthroses were symptomatic at latest follow-up or at the time of further surgery. Of the 32 patients, 9 had a symptom-free period of at least 2 years after the anterior cervical discectomy and fusion before redeveloping cervical symptoms after a traumatic episode. Of 48 patients with pseudarthroses, 16 (33%) remained asymptomatic at a mean of 5.1 years after anterior cervical discectomy and fusion. A younger age at the time of anterior cervical discectomy and fusion increased the likelihood of the pseudarthrosis becoming symptomatic. After multiple level anterior cervical discectomy and fusion, the caudal-most operated level accounted for 82% of the pseudarthroses. Sixteen patients had an anterior repair of the pseudarthrosis, and fusion was achieved in 14. Six patients underwent posterior pseudarthrosis repair, and all healed. In patients in whom fusion was achieved with a second cervical operation, the results were excellent in 19 and good in 1.
A pseudarthrosis after anterior cervical discectomy and fusion is frequently associated with a poor clinical outcome. Surgical repair of the pseudarthrosis with an anterior or posterior approach seems to have a high likelihood of a successful clinical outcome.
一项对48例颈椎前路椎间盘切除融合术后假关节形成患者长期临床结局的回顾性研究。
确定大量有记录的颈椎前路椎间盘切除融合术后假关节形成患者的自然病史、危险因素及治疗结果。
近期报告表明，颈椎前路椎间盘切除融合术后假关节形成会对临床结局产生不利影响。关于颈椎假关节形成的数据发表较少，且结论多来自小样本患者群体和短期随访期的报告。
对48例经影像学证实颈椎前路椎间盘切除融合术后假关节形成的患者进行研究。定期对患者进行检查并拍摄X线片（平均随访66个月）。临床结果基于患者对疼痛、处方药使用、活动水平及奥多姆标准的评估。报告了接受假关节手术修复患者的临床结局。
48例患者中，32例（67%）假关节形成患者在最后一次随访时或再次手术时出现症状。32例患者中，9例在颈椎前路椎间盘切除融合术后至少有2年无症状期，之后在一次创伤事件后再次出现颈椎症状。48例假关节形成患者中，16例（33%）在颈椎前路椎间盘切除融合术后平均5.1年仍无症状。颈椎前路椎间盘切除融合术时年龄较小会增加假关节形成出现症状的可能性。多节段颈椎前路椎间盘切除融合术后，最尾端的手术节段假关节形成占82%。16例患者进行了假关节前路修复，14例实现融合。6例患者接受了假关节后路修复，均愈合。在通过二次颈椎手术实现融合的患者中，19例结果为优，1例为良。
颈椎前路椎间盘切除融合术后假关节形成常与不良临床结局相关。采用前路或后路手术修复假关节似乎有很高的临床成功可能性。
