Revision surgeries following artificial disc replacement of cervical spine.
Revision surgeries following artificial disc replacement of cervical spine.
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DOI：
10.1016/j.aott.2016.04.004
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发表时间：
2016-12
影响因子：
1
通讯作者：
Lee JC
中科院分区：
文献类型：
--
作者：
Park JB;Chang H;Yeom JS;Suk KS;Lee DH;Lee JC
我们调查了颈椎人工椎间盘置换(C-ADR)后翻修手术的原因和结果。21名患者(平均年龄：52.8岁)在C-ADR后接受了翻修手术，并且至少有2年的随访期。初次手术和再次手术之间的平均时间为21个月。其中14例为单节段C-ADR手术，2例为两节段C-ADR手术，5例为两节段混合手术，16例为神经根病变，3例为脊髓病变，2例为邻近节段病变。翻修手术的原因至少有以下一种：17例患者选择不当，7例减压不充分，7例错位，6例下陷，3例骨溶解，1例术后感染。16例行前路C-ADR摘除、单节段椎体切除植骨融合术(N=911)、双节段椎体切除植骨融合术(N=3)或单节段椎体切除融合术(N=2)。3例龙骨型C-ADR合并异位骨化患者行椎板后路椎板开窗植骨融合术。2例患者因感染或严重塌陷、骨溶解而接受联合手术。随访2年，颈部(7.3vs1.6)和ARM(7.0vs1.3)视觉模拟评分和颈部残疾指数评分(46.7vs16.32)均有改善(P均<0.05)。根据奥多姆的标准，86%的患者满意，91%的患者达到了坚实的融合。除6例(29%)患者出现一过性吞咽困难外，无其他严重并发症发生。在这个小病例系列中，翻修手术在失败的C-ADR中提供了成功的结果，没有重大并发症。仔细的患者选择和细致的手术技术对于避免令人失望的临床结果甚至C-ADR的失败是非常重要的。第四级，治疗性研究。
We investigated causes and results of revision surgeries after artificial disc replacement of cervical spine (C-ADR). Twenty-one patients (mean age: 52.8) who underwent revision surgery after C-ADR and who had a minimum 2-year of follow-up were included into this study. The mean time between the primary and revision surgeries was 21 months. During their primary surgeries, 14 patients underwent single level C-ADR, 2 two-level C-ADR, and 5 two-level hybrid surgery for 16 radiculopathy, 3 myelopathy, and 2 adjacent segment diseases. Causes for revision surgeries were at least one of the followings: 17 poor patient selections, 7 insufficient decompressions, 7 malpositions, 6 subsidences, 3 osteolysis, and 1 postoperative infection. Sixteen patients underwent anterior removal of C-ADR, one-level discectomy and fusion (N = 11), two-level discectomy (N = 3) or one-level corpectomy (N = 2) and fusion. Three patients of keel type C-ADR with heterotopic ossification underwent posterior laminoforaminotomy and fusion. Two patients underwent combined procedures due to infection or severe subsidence and osteolysis. At the 2-year follow-up, neck (7.3 vs 1.6) and arm (7.0 vs 1.3) visual analog scales and Neck Disability Index score (46.7 vs 16.32) were improved (all, p < 0.05). According to Odom's criteria, 86% of the patients were satisfied and 91% achieved solid fusion. No major complications developed except for transient dysphagia in 6 patients (29%). In this small case series, revision surgeries provided successful outcomes in failed C-ADR without major complications. Careful patient selection and meticulous surgical techniques are important to avoid disappointing clinical outcome or even failure of C-ADR. Level IV, Therapeutic study.
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影响因子：
2.7
作者：
Cheng, Lei;Nie, Lin;Hou, Yong
通讯作者：
Hou, Yong
影响因子：
--
作者：
Sekhon, LHS
通讯作者：
Sekhon, LHS
影响因子：
4.5
作者：
Singh, Kern;Phillips, Frank M.;Goldberg, Edward J.
通讯作者：
Goldberg, Edward J.
影响因子：
4.5
作者：
Nandyala, Sreeharsha V.;Marquez-Lara, Alejandro;Singh, Kern
通讯作者：
Singh, Kern
影响因子：
2.8
作者：
Burkus, J. Kenneth;Traynelis, Vincent C.;Mummaneni, Praveen V.
通讯作者：
Mummaneni, Praveen V.