颈前路减压融合术对伴有Modic-2型改变颈椎病的术后疗效分析

Therapeutic effects of anterior cervical discectomy and fusion on cervical spondylosis with Modic-2 type changes

目的探讨颈椎Modic-2型改变对单节段前路颈椎间盘切除融合术(ACDF)的临床疗效的影响。方法回顾性分析单节段ACDF患者79例,根据患者手术节段的相邻节段是否存在Modic-2型改变把患者分为2组,A组37例伴有Modic-2型改变,B组42例不伴有Modic-2型改变。术前进行临床和影像学评价,术后3、6、12个月和24个月进行随访及影像学评价。结果所有患者均获随访。NDI、JOA、术后改善率方面2组患者得到明显改善(P<0.05),2组间差异无统计学意义(P>0.05)。术后X线检查显示A组2例,B组3例术后出现相邻阶段退变(ASD),2组的ASD发生率差异无统计学意义(P>0.05)。A组患者术后轴向症状VAS评分与B组比较,1年及2年随访时评分较高,差异有统计学意义(P<0.05)。结论伴有或不伴有Modic-2型的颈椎病患者,ACDF术后皆得到了良好的术后改善率;对于单节段颈椎病行ACDF的患者,邻近节段伴有Modic-2型改变并不会影响术后ASD的发生及节段活动度;但是对于伴有Modic-2型改变的患者,术后可能会影响其轴性症状的恢复。

Objective To investigate the effects of Modic-2 type changes on clinical curative effects of anterior cervical discectomy and fusion(ACDF)in treatment of cervical spondylosis.Methods The clinical data about 79 patients who underwent single segment ACDF were retrospectively analyzed.The patients were divided into two groups according to whether there were Modic-2 changes in the adjacent segments of the surgical segment.The 37 patients in group A were accompanied by Modic-2 type changes,however,the 42 patients in group B were not accompanied by Modic-2 type changes.Clinical and imaging evaluations were performed before operation and at 3m,6m,12m and 24m after operation,with postoperative follow up.Results All the patients were followed up for 24 months.The NDI,JOA and postoperative improvement rate were significantly improved in both groups(P<0.05),however there were no significant differences between the two groups(P>0.05).The postoperative X-ray examination showed that there were 2 cases of adjacent stage degeneration(ASD)in group A and there were 3 cases of ASD in group B,there was no significant difference in incidence rate of ASD between two groups(P>0.05).The 1-year and 2-year axial symptom VAS scores after operation in group A were significantly higher tha nthose in group B(P<0.05).Conclusion The patients with or without Modic-2 type cervical spondylosis have good postoperative improvement rate after ACDF.For the patients with single segment cervical spondylosis,adjacent segments with Modic-2 type changes do not affect the incidence of postoperative ASD and segmental activity degree,however,for the patients with type Modic-2 changes,the postoperative recovery of axial symptoms may be influenced.