경추 퇴행성 질환 환자에서 Cage만을 이용한 2구간 경추 감압술 및 골유합술 = Two-Level Anterior Cervical Discectomy and Fusion with Stand-alone Cages in Cervical Spinal Degenerative Diseases

다국어 초록 (Multilingual Abstract)

Objective: Anterior cervical discectomy and fusion (ACDF) is a highly successful surgical treatment for nerve root or
spinal cord compression caused by disc herniation or spondylosis. Multilevel cervical discectomy usually requires plate
and screw fixation for adequate bony fusion and stability. But the use of plate and screw fixation may cause some
post-operative complications. So in this study we evaluate the safety and effectiveness of two-level ACDF with carbon or
polyetheretherketone (PEEK) cages without cervical plate in cervical degenerative disc disease.
Methods: We retrospectively analyzed 18 patients who underwent two-level ACDF with carbon or PEEK cages from February
2002 to August 2008. The mean follow-up period was 31months. Clinical, radiologic and surgical morbidities were
assessed in all cases. Outcome assessment was done using Odom’s criteria and visual analogue scale (VAS) score. Radiological
assessment was done with bony fusion rate, linear measure of cervical lordosis, cervical lordotic angle and cage
subsidence.
Results: Radiculopathy was improved in all cases (100%) after surgery, whereas myelopathy was resolved in three of five
patients (60%). Radiographic evidence of fusion was found in all patients (100%) at last follow-up. Preoperative mean VAS
score was 8.1 compared with a postoperative score 2.5 (p<0.05). The clinical outcome was excellent or good in 16
cases (89%). There were no serious complications such as dislodgement of cages, hardware failure, infection and neurologic
deterioration. Linear measure of cervical lordosis at last follow-up was increased from 2.72 ± 1.12 mm to 7.84 ± 1.09 mm.
Cervical lordotic angle at last follow-up was increased from 8.9 ± 2.76° to 15.1 ± 2.38°. The mean loss of disc height
was 1.40 mm during the follow-up period. However development of subsidence did not influence on clinical outcomes.
Conclusion: ACDF in two-level stand-alone cages is a safe and effective procedure in multilevel cervical degenerative
diseases. In spite of subsidence, interbody fusion with cages provides load-sharing function and stabilization of the
cervical spine by increasing segmental rigidity, thus yielding excellent fusion rates and less graft failure, even in twolevel
cervical diseases.

다국어 초록 (Multilingual Abstract)

Objective: Anterior cervical discectomy and fusion (ACDF) is a highly successful surgical treatment for nerve root or
spinal cord compression caused by disc herniation or spondylosis. Multilevel cervical discectomy usually requires plate
and screw fixation for adequate bony fusion and stability. But the use of plate and screw fixation may cause some
post-operative complications. So in this study we evaluate the safety and effectiveness of two-level ACDF with carbon or
polyetheretherketone (PEEK) cages without cervical plate in cervical degenerative disc disease.
Methods: We retrospectively analyzed 18 patients who underwent two-level ACDF with carbon or PEEK cages from February
2002 to August 2008. The mean follow-up period was 31months. Clinical, radiologic and surgical morbidities were
assessed in all cases. Outcome assessment was done using Odom’s criteria and visual analogue scale (VAS) score. Radiological
assessment was done with bony fusion rate, linear measure of cervical lordosis, cervical lordotic angle and cage
subsidence.
Results: Radiculopathy was improved in all cases (100%) after surgery, whereas myelopathy was resolved in three of five
patients (60%). Radiographic evidence of fusion was found in all patients (100%) at last follow-up. Preoperative mean VAS
score was 8.1 compared with a postoperative score 2.5 (p<0.05). The clinical outcome was excellent or good in 16
cases (89%). There were no serious complications such as dislodgement of cages, hardware failure, infection and neurologic
deterioration. Linear measure of cervical lordosis at last follow-up was increased from 2.72 ± 1.12 mm to 7.84 ± 1.09 mm.
Cervical lordotic angle at last follow-up was increased from 8.9 ± 2.76° to 15.1 ± 2.38°. The mean loss of disc height
was 1.40 mm during the follow-up period. However development of subsidence did not influence on clinical outcomes.
Conclusion: ACDF in two-level stand-alone cages is a safe and effective procedure in multilevel cervical degenerative
diseases. In spite of subsidence, interbody fusion with cages provides load-sharing function and stabilization of the
cervical spine by increasing segmental rigidity, thus yielding excellent fusion rates and less graft failure, even in twolevel
cervical diseases.

참고문헌 (Reference)

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