Emery S E, Fisher J R, Bohlman H H
Department of Orthopaedic Surgery, University Hospitals Spine Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
Spine (Phila Pa 1976). 1997 Nov 15;22(22):2622-4; discussion 2625. doi: 10.1097/00007632-199711150-00008.
A retrospective study of 16 patients who underwent the modified Robinson anterior cervical discectomy and fusion at three operative levels.
To provide long-term follow-up data on the surgical success and patient outcome of three-level anterior cervical discectomies and fusions.
The success of arthrodesis for anterior cervical fusion depends on several factors, including the number of surgical levels. To the authors' knowledge, there are no long-term follow-up reports to describe the arthrodesis rate and outcome for patients having specifically three-level discectomy and fusion procedures.
Sixteen patients, with an average age of 59 years, were followed for an average of 37 months. All had an anterior discectomy, burring of the endplates, and placement of an autogenous tricortical iliac crest graft at three levels. All patients had follow-up office visits with examinations and radiographs. Radiographic union, postoperative pain relief, and neurologic recovery were evaluated.
Only 9 (56%) of the 16 patients went on to achieve solid arthrodesis at all three levels. Of the seven patients with pseudarthrosis, two had severe pain and required revision; two had moderate pain and three no pain. Of the nine with the solid fusion, three had mild pain and six no pain, a statistically significant difference in comparing the two outcomes (P < 0.01). All patients with preoperative motor deficit recovered, but two patients in whom a pseudarthrosis had developed had limited improvement in function until the nonunion was surgically repaired.
A three-level modified Robinson cervical discectomy and fusion results in an unacceptably high rate of pseudarthrosis. Although not all pseudarthroses are painful, these data suggest that those with a successful fusion have a better outcome. It is recommended that these patients undergo additional or alternative measures to achieve arthrodesis consistently.
对16例行三节段改良罗宾逊前路颈椎间盘切除融合术的患者进行回顾性研究。
提供三节段前路颈椎间盘切除融合术手术成功率及患者预后的长期随访数据。
颈椎前路融合术的融合成功取决于多种因素，包括手术节段数量。据作者所知，尚无长期随访报告描述特定三节段椎间盘切除融合术患者的融合率及预后。
16例患者，平均年龄59岁，平均随访37个月。所有患者均接受了前路椎间盘切除、终板打磨，并在三个节段植入自体三面皮质髂嵴骨块。所有患者均接受门诊随访及检查和影像学检查。评估影像学融合、术后疼痛缓解及神经功能恢复情况。
16例患者中仅9例（56%）在所有三个节段均实现了牢固融合。在7例假关节形成的患者中，2例有严重疼痛，需要翻修；2例有中度疼痛，3例无疼痛。在9例实现牢固融合的患者中，3例有轻度疼痛，6例无疼痛，两种结果比较差异有统计学意义（P<0.01）。所有术前有运动功能障碍的患者均恢复，但2例发生假关节形成的患者在未进行手术修复骨不连之前，功能改善有限。
三节段改良罗宾逊颈椎间盘切除融合术导致假关节形成率高得令人难以接受。虽然并非所有假关节都会引起疼痛，但这些数据表明，融合成功的患者预后更好。建议这些患者采取额外或替代措施以持续实现融合。
