Objective To explore the surgical treatment strategy for adjacent segment disease (ASD) after anterior cervical discectomy and fusion of multi-segments. Methods From 2015 to 2019, 13 patients with ASD in our hospital were retrospectively analyzed. Eight patients were treated with anterior cervical Zero-P plate and 5 patients were treated with single-door laminoplasty. JOA, VAS, and NDI were noted to evaluate the clinical outcomes, and X-ray, CT, and MRI imaging were recorded and analyzed as well. Results All the patients were followed up for an average of 11.6 months (6~24 months). The JOA, VAS and NDI were significantly improved after both surgeries. In the anterior cervical operation group, the position of the internal fixation was good and no loosening of the plate screw was observed during follow-up. The average time of bone fusion was about 7.6 months. In patients who were treated with single-door laminoplasty, there were no complications such as C5 nerve root palsy, lamina re-closing and so on. Conclusions The selection of reoperation methods for ASD after multilevel anterior cervical fusion should follow the principle of individualization. For single-level ASD without severe posterior longitudinal ligament ossification, anterior decompression and fusion with the Zero-P system should be selected. For multi-levels ASD, the posterior single-door laminoplasty is preferred.
Key words
Cervical discectomy and fusion /
/
/
Adjacent segment disease /
/
/
Anterior approach /
Posterior approach /
/
/
/
Reoperation
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Harada GK, Alter K, Nguyen AQ, et al. Cervical Spine endplate abnormalities and association with pain, disability, and adjacent segment degeneration after anterior cervical discectomy and fusion[J]. Spine (Phila Pa 1976), 2020, 45(15): E917-E926. DOI: 10.1097/BRS.0000000000003460.
[2] Hirvonen T, Siironen J, Marjamaa J, et al. Anterior cervical discectomy and fusion in young adults leads to favorable outcome in long-term follow-up[J]. Spine J, 2020, 20(7): 1073-1084. DOI: 10.1016/j.spinee.2020.03.016.
[3] Lawrence BD, Hilibrand AS, Brodt ED, et al. Predicting the risk of adjacent segment pathology in the cervical spine: a systematic review[J]. Spine (Phila Pa 1976), 2012, 37(22 Suppl): S52-S64. DOI: 10.1097/brs.0b013e31826d60fb.
[4]Hussain M, Nassr A, Natarajan RN, et al. Biomechanics of adjacent segments after a multilevel cervical corpectomy using anterior, posterior, and combined anterior-posterior instrumentation techniques: a finite element model study[J]. Spine J, 2013, 13(6): 689-696. DOI: 10.1016/j.spinee.2013.02.062.
[5] Matsumoto M, Okada E, Ichihara D, et al. Anterior cervical decompression and fusion accelerates adjacent segment degeneration: comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study[J]. Spine, 2010, 35(1): 36-43. DOI: 10.1097/BRS.0b013e3181b8a80d.
[6] Chan SC，Ferguson SJ，Wuertz K，et al. Biological response of the intervertebral disc to repetitive short-term cyclic torsion[J]. Spine, 2011, 36(24): 2021-2030. DOI: 10.1097/BRS.0b013e318203aea5.
[7] 韦竑宇, 蒋欣, 谭明生. 颈椎前路钢板固定融合术后邻近节段骨化发生的因素[J]. 中日友好医院学报, 2009, 23(2): 70-72. DOI: 10.3969/j.issn.1001-0025.2009.02.002.
[8] 罗春山, 赵国权, 梁栋柱, 等. C5/6椎间隙不同撑开高度对临近椎间盘压力的研究分析[J]. 中国临床解剖学杂志, 2015, 33(6): 696-699. DOI: 10.13418/j.issn.1001-165x.2015.06.017.
[9] Zhang Yijian, Shao Yijie, Liu Hao, et al. Association between sagittal balance and adjacent segment degeneration in anterior cervical surgery: a systematic review and meta-analysis[J]. BMC Musculoskelet Disord, 2019, 20(1): 430. DOI: 10.1186/s12891-019-2800-0.
[10]Coric D, Kim PK, Clemente JD, et al. Prospective randomized study of cervical arthroplasty and anterior cervical discectomy and fusion with long-term follow-up: results in 74 patients from a single site[J]. J Neurosurg Spine, 2013, 18(1): 36-42. DOI: 10.3171/2012.9.SPINE12555.
[11]盛斌, 黄象望, 向铁城, 等. 人工颈椎间盘置换治疗前路颈椎减压融合术后相邻节段病的中期随访观察[J]. 中国脊柱脊髓杂志, 2012, 23(11): 1050-1052. DOI: 10.3969/j.issn.1004-406X.2013.11.23.
PDF(3631 KB)
