椎间融合器置入前路三节段椎间盘切除修复颈椎病:20例远期随访

Multilevel cage-assisted anterior decompression and fusion for cervical spondylosis: long-term outcomes in 20 cases

背景:脊柱融合的理想方法是椎体间融合,该法用于颈椎则是由Robinson和Smith在1955年从颈椎前方对突出的椎间盘进行摘除,并予以椎体间植骨。随后又提出在椎体间放置内容物促进脊柱融合的设想。此后,脊柱椎体间植骨融合有了较大的发展,并成为治疗脊柱退行性变的标准方法之一。目的:分析颈椎前路三节段椎间隙减压椎间融合器置入修复颈椎病的长期临床效果。方法:2000年10月至2002年10月解放军306医院骨科收治了20例颈椎病患者行颈椎前路三节段椎间盘切除、颈椎椎间融合器置入,男15例,女5例;年龄48-65岁,平均56.4岁;病变节段:12例C4-7,8例C3-6。比较治疗前及末次随访JOA评分,评价其改善率;记录治疗后Odom分级。测量治疗前、治疗后及末次随访时颈椎正侧位X射线片,观察颈椎生理曲度(Cobb角)、手术节段融合和邻近节段退变情况。结果与结论:20例患者顺利完成融合治疗,无神经系统及与内固定物相关的并发症发生。随访时间10-132个月。治疗前JOA评分(9.85±0.81)分,末次随访(14.40±0.94)分,差异有显著性意义,平均改善率为81%。末次随访时Odom分级:优14例,良4例,一般2例。未观察到邻近节段病变,有2例出现Cage沉降,颈椎生理弯曲保持良好,在末次随访时骨性融合率为100%。治疗后1年、末次随访时颈椎前凸Cobb角均显著高于治疗前(P<0.05);治疗后1周与末次随访时比较,差异无显著性意义(P>0.05)。提示颈前路椎间盘切除减压、椎间融合器置入修复三节段颈椎病是一种有效的治疗方式,长期随访效果满意。

BACKGROUND： Ideal method for spinal fusion is interbody fusion, which was firstly applied by Robinson and Smith in 1955 on the removal of herniated intervertebral discs through the anterior cervical approach, followed by interbody grafting. Subsequently the presumption of interbody contents emerges to promote spinal fusion. The spinal interbody fusion has achieved significant developments and is considered one of standard treatments for spinal degeneration. OBJECTIVE： To investigate the long-term efficacy of multilevel anterior cervical decompression and cage-assisted fusion for cervical spondylosis. METHODS： From October 2000 to October 2002, twenty cases with cervical spondylosis underwent three-level cage-assisted anterior cervical depression and fusion in the 306 Hospital of Chinese PLA （including 15 males and 5 females）. The involved patients aged 48-65 years, with mean 56.4 years. The affected lesions were observed at the C4-7 level in 12 cases and at the C3-6 level in 8 cases. JOA scores were recorded before treatment and at final follow-up to evaluate the improvement rate. Clinical results were graded using the Odom criteria. Radiological results at the anterioposterior and lateral film positions were observed before and after treatment, as well as at final follow-up. Cervical spine curvature （Cobb angle） was measured before and after treatment. Adjacent segment degeneration and graft fusion rate were observed upon final follow-up. RESULTS AND CONCLUSION： All 20 patients were successfully operated. No neurological and fixation-related complications occurred. The follow-up period was arranged from 10 to 132 months. The JOA score was （9.85 ± 0.81） preoperatively and （14.40 ± 0.94） postoperatively, showing significant difference. The average JOA improvement rate was 81%. Odom grading at final follow-ups included 14 excellent cases, 4 good cases, and 2 fair cases. No adjacent segment lesions were observed, Cage sedimentation was visible in two cases, and cervical curve maintained good. Graft fusion rate was 100% at final follow-up. Radiograph analysis indicated that, Cobb angle of cervical lordosis was significantly higher at postoperative 1 year and at final follow-up compared with preoperative measurement （P 〈 0.01）, and no difference was significant between postoperative 1 year and final follow-up （P 〉 0.05）. Multilevel cage-assisted anterior cervical decompression and fusion is an effective and safe way for multilevel cervical spondylosis and the long-term outcomes are good.