■由于关节固定术的可靠率,采用侧块螺钉的后颈椎融合术(PCF)是改善有症状的假关节的有利治疗选择;然而,这种技术增加了伤口感染和再入院的风险。涉及关节面固定器械的保留组织的PCF方法可降低术后并发症的发生率,同时稳定症状水平以实现关节固定术;然而,这些结局仅限于来自个别外科医生的小型研究队列,这些外科医生通常具有混合治疗适应症.
■150例病例来自美国6个地点的7名外科医生进行的回顾性图表审查。所有病例均在颈椎前路椎间盘切除术和融合术(ACDF)后从C3到C7的一个或多个级别进行了PCF翻修。PCF是使用小平面器械的组织保留技术进行的。涉及额外补充固定的病例,如侧块螺钉,棒,电线,或其他硬件被排除在外。人口统计,操作注释,术后并发症,医院再入院,和随后的手术干预被总结为一个完整的队列,并根据以下风险因素:年龄,性别,修订的级别数,体重指数(BMI),和尼古丁使用史。
■PCF翻修时患者的平均年龄为55±11岁,63%为女性。平均BMI为29±6kg/m2,有19%的人报告有尼古丁使用史。术后随访的中位数为68天(四分位距=41-209天),从修订PCF开始。有91个1级,492级,83级,24±水平PCF翻修病例。平均手术时间为52±3分钟,估计失血量为14±1.5cc。参与者在手术后平均1±0.05天出院。多级治疗导致更长的手术时间(单次=45分钟,multi=59min,P=0.01),但不影响估计的失血量(P=0.94)。通过多级治疗,医院的总夜晚增加了0.2个夜晚(P=0.01)。性,年龄,尼古丁病史,BMI对记录的围手术期结局无影响.有一次因深静脉血栓而再次住院,用ACDF治疗的1例修订水平的持续性假关节,和四个相邻节段疾病的实例。在最初接受多水平ACDF治疗的患者中,修订最常见于尾部水平(修订水平的48%),其次是颅骨(43%),最不经常处于中等水平(9%)。
此围手术期和安全性结果的图表回顾提供了证据,支持保留组织的PCF与小关节器械治疗ACDF后有症状的假关节。需要翻修的最常见位置是尾和颅骨水平。与开放式替代方案相比,手术持续时间和估计的失血量是有利的。术后没有伤口感染,大多数患者在手术后第二天出院。
UNASSIGNED: Posterior cervical fusion (PCF) with lateral mass screws is a favorable treatment option to revise a symptomatic
pseudarthrosis due to reliable rates of arthrodesis; however, this technique introduces elevated risk for wound infection and hospital readmission. A tissue-sparing PCF approach involving facet fixation instrumentation reduces the rates of postoperative complications while stabilizing the symptomatic level to achieve arthrodesis; however, these outcomes have been limited to small study cohorts from individual surgeons commonly with mixed indications for treatment.
UNASSIGNED: One hundred and fifty cases were identified from a retrospective chart review performed by seven surgeons across six sites in the United States. All cases involved PCF revision for a
pseudarthrosis at one or more levels from C3 to C7 following anterior cervical discectomy and fusion (ACDF). PCF was performed using a tissue-sparing technique with facet instrumentation. Cases involving additional supplemental fixation such as lateral mass screws, rods, wires, or other hardware were excluded. Demographics, operative notes, postoperative complications, hospital readmission, and subsequent surgical interventions were summarized as an entire cohort and according to the following risk factors: age, sex, number of levels revised, body mass index (BMI), and history of nicotine use.
UNASSIGNED: The average age of patients at the time of PCF revision was 55 ± 11 years and 63% were female. The average BMI was 29 ± 6 kg/m2 and 19% reported a history of nicotine use. Postoperative follow-up visits were available with a median of 68 days (interquartile range = 41-209 days) from revision PCF. There were 91 1-level, 49 2-level, 8 3-level, and 2 4±-level PCF revision cases. The mean operative duration was 52 ± 3 min with an estimated blood loss of 14 ± 1.5cc. Participants were discharged an average of 1 ± 0.05 days following surgery. Multilevel treatment resulted in longer procedure times (single = 45 min, multi = 59 min, P = 0.01) but did not impact estimated blood loss (P = 0.94). Total nights in the hospital increased by 0.2 nights with multilevel treatment (P = 0.01). Sex, age, nicotine history, and BMI had no effect on recorded perioperative outcomes. There was one instance of rehospitalization due to deep-vein thrombosis, one instance of persistent
pseudarthrosis at the revised level treated with ACDF, and four instances of adjacent segment disease. In patients initially treated with multilevel ACDF, revisions occurred most commonly on the caudal level (48% of revised levels), followed by the cranial (43%), and least often in the middle level (9%).
UNASSIGNED: This chart review of perioperative and safety outcomes provides evidence in support of tissue-sparing PCF with facet instrumentation as a treatment for symptomatic
pseudarthrosis after ACDF. The most common locations requiring revision were the caudal and cranial levels. Operative duration and estimated blood loss were favorable when compared to open alternatives. There were no instances of postoperative wound infection, and the majority of patients were discharged the day following surgery.