Preliminary Experience with Anterior Interbody Titanium Cage Fusion for Treatment of Cervical Disc Disease

利用金屬椎間籠進行前位頸椎融合術治療椎間盤疾病之經驗

林忠男(Chung-Nan Lin) ； 吳玉娟(Yu-Chuan Wu) ； 王乃弘(Nai-Phou Wang) ； 洪純隆(Shen-Long Howng)

《The Kaohsiung Journal of Medical Sciences》 19卷5期 (2003/05) Pp. 208-216

摘要

本文利用鈦金屬椎間籠融合重建退化性頸椎病變。研究對象近4年內治療的34例患者。手術方式為經前位項椎進行顯微椎間盤切除術，術後並植入7-10mm不同尺寸的人工鈦金屬椎間籠來重建脊椎。手術部位包括制3至第7節頸椎，病灶均為單一節數。經由頸椎之動態Ｘ光，電腦斷層攝影以反磁振掃描來診斷並確定病灶。術後追蹤期間由5個月至4年不等。結論顯示該手術方式是比傳統的自體骨移植方法有較少的合併症及更佳的穩定度。所有病患皆無手術中或手術後合併症的發生且無取骨處及移植處之併發症。手術的操作容易及時間的縮短（平均約省35分鐘），手術中出血的減少（平均出血量75mＬ）以及能早期下床活動（住院天數均少於5天），使其較傳統Cloward及Smith-Robinson的手術有利 。症狀的改善也令人滿意。頸椎動態Ｘ光之追蹤檢查顯示所有的病患之手術部位皆有穩定的椎間籠－椎體間的融合，也無植入物脫出，移位造成的假性癒合。本文雖有三例發生術後脊椎輕微下陷情形，但並不影響其愈後。也有5例於術後6-12個月後漸漸形成椎體前皮質之跨橋式骨盾證實了穩定的骨癒合。

關鍵字

椎間籠 ； 頸椎融合術 ； 椎間盤疾病

並列摘要

This study evaluated the efficacy and safety of titanium cage implants in cervical recon-struction to treat cervical spondylosis. Surgical data covered a 4-year period from January 1999 to December 2002 and included 34 consecutive patients,20 men and 14 women ,with ages ranging from 27 to 84 years (mean,57 years ). Patients underwent anterior cervical microdiscectomy followed by interbody fusion with a titanium cage implant (rather than 1 autogenous iliac crest bone graft) at a single level ranging from C3 to C7. Twenty-one patients had a herniated intervertebral disc, nine had degenerative disc disease, and four had previous failed autograft fusion surgery that required revision. At clinical presentation,26 patients had neck pain, 23 had radiculopathy, and nine had myelopathy. Diagnostic lagging studies included spinal dynamic roentgenography, computerized tomography, and, magnetic resonance imaging. Lesions were located at C3-4 in seven cases, C4-5 in 14 cases, )-6 in nine cases, and C6-7 in four cases. The follow-up period ranged from 7 to 48 months (mean, 26 months). Results revealed that the procedure was technically feasible. There were 0 intra- or postoperative complications. The most commonly used cage was 9 mm high. Imaging studies showed no cage instability, migration, or pseudarthrosis. Although mild subsidence ＜ 5 mm) was observed in three cases, these patients preserved adequate postoperative cervical lordosis and the subsidence did not preclude a good clinical result. The advantages of is procedure over a similar operation using traditional tricorticate bone graft are: no graft ,morbidity; shorter operation time (mean time saved, 35 minutes); reduced blood loss (average \ blood loss, 75 mL); and early postoperative ambulation (mean, 4.7 hospital days). Nearly all patients rapidly lost their neck pain (92%, 24/6) and radicular symptoms (87%, 20/23) after surgery. The recovery rate from myelopathy was 44% (4/9). Progressive bony shield formation over the anterior / posterior cortex (sentinel sign) indicated fusion in five cases.

並列關鍵字

titanium cage ； anterior fusion ； cervical disc disease