전방 경추 추간판 제거술 및 유합술 후 인접분절의 골극 형성에 대한 관여인자

국문 초록 (Abstract)

목적: 전방 경추 추간판 제거술 및 유합술 후 인접분절 골화 형성의 발생에 영향을 미치는 인자에 대해서 알아보고자 하였다.
대상 및 방법: 전방 경추 추간판 제거술 및 유합술을 시행 받은 75명의 환자를 대상으로 하였다(외상 28명,퇴행성 경추질환 47명). 추시중 골화의 발생 시기 및 빈도를 확인하였고 외상군과 퇴행성 질환군에 따른 발생 빈도를 비교하여 연부조직 손상이 미치는 영향을 알고자 하였다. 유합 범위, 나이, 수술 시간 등과의 연관성에 대해서도 조사하였다.
결과: 총 33예(44%)의 환자에서 골화가 관찰되었다. 술 후 1년 이내 관찰된 경우가 5예(15%), 1-2년 사이에 관찰된 경우가 10예(30%), 2-3년 사이에 관찰된 경우가 13예(40%), 3년 이후 관찰된 경우가 5예(15%)였다. 유합 범위만이 골화의 발생과 통계학적으로 의미있는 연관을 보였다(p〈0.001). 외상군과 질병군의 비교에서 골화의 발생빈도는 유의한 차이를 보이지 않았다(p=0.63).
결론: 인접분절 골화 형성은 술 후 관찰되기까지 상당기간의 추시가 필요하며 연부조직의 손상 정도보다는 유합에 따른 인접분절의 과도한 부하가 발생에 더 큰 영향을 미칠 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study is to analyze the affecting factors of adjacent level ossification development (ALOD) after anterior cervical discectomy and fusion.
Materials and Methods: This study enrolled 75 patients who underwent anterior cervical discectomy and fusion and were followed-up for more than two years. Twenty-five patients were related with trauma and 47 patients were diagnosed as degenerative cervical disorder. We assessed the incidence, location and timing of ALOD, and compared the incidence of ossification between trauma and degenerative disease groups to know the effect of soft tissue damage. We also reviewed the correlation between the development of ossification at adjacent level and the factors, such as fusion level, age, operation time, duration of follow-up, and the presence of ossification of posterior longitudinal ligament (OPLL), as well as ossification of yellow ligament (OYL).
Results: Ossification developed in 33 patients (44%). Five cases (15%) were detected during the first year after surgery, 10 (30%) cases detected during the second year after surgery, 13 (40%) between second and third year, and 5 (15%) cases of more than three years after surgery. Only the fusion level was related with the development of ossification statistically (p<0.001). Age, operation time, duration of follow-up, sex ratio, presence of OPLL, and OYL were not related with the incidence of ossification significantly. There was no significant difference in the incidence of ALOD between the trauma group and degenerative disease group (p=0.3625).
Conclusion: To detect ALOD, it needs a long time for follow-up after surgery. We thought that ALOD is affected by excessive loading at the adjacent level after fusion rather than severity of the soft tissue damage.

목차 (Table of Contents)

• 서론
• 대상 및 방법
• 결과
• 고찰
• 결론
• 참고문헌

참고문헌 (Reference)

1 Park JB., "Timing of development of adjacent-level ossification after anterior cervical arthrodesis with plates" 7 : 633-636, 2007

2 Smith GW., "The treatment of certain cervicalspine disorders by anterior removal of the intervertebral disc and interbody fusion" 40 : 607-624, 1958

3 Nagata H., "The effects of immobilization of long segments of the spine on the adjacent and distal facet force and lumbosacral motion" 18 : 2471-2479, 1993

4 Kolstad F., "Segmental motion adjacent to anterior cervical arthrodesis : a prospective study" 32 : 512-517, 2007

5 Mähring M, "Segment changes in the cervical spine following cervical spondylodeses of unstable injuries" 14 : 247-258, 1988

6 Bohlman HH., "Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients" 75 : 1298-1307, 1993

7 Garland DE., "Resection of heterotopic ossification in patients with spinal cord injuries" (242) : 169-176, 1989

8 Modabber MR., "Reconstruction for post-traumatic conditions of the elbow joint" 77 : 1431-1446, 1995

9 Aota Y., "Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders" 8 : 464-473, 1995

10 Jeong Yoon Park, "New Technical Tip for Anterior Cervical Plating : Make Hole First and Choose the Proper Plate Size Later" 대한신경외과학회 49 (49): 212-216, 2011

11 Goffin J., "Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine" 8 : 500-508, 1995

12 Kim KS, "Long-term effects on the cervical spine after anterior locking plate fixation" 30 : 493-500, 2001

13 Braunstein EM., "Long term radiographic changes following anterior cervical fusion" 31 : 201-203, 1980

14 Döhler JR., "Instability of the cervical spine after anterior interbody fusion. A study on its incidence and clinical significance in 21 patients" 104 : 247-250, 1985

15 Purtill JJ., "Heterotopic ossification. Incidence in cemented versus cementless total hip arthroplasty" 11 : 58-63, 1996

16 Hasegawa M., "Heterotopic ossification around distal femur after total knee arthroplasty" 122 : 274-278, 2002

17 Sperling JW., "Heterotopic ossification after total shoulder arthroplasty" 15 : 179-182, 2000

18 Park JB., "Development of adjacent-level ossification in patients with an anterior cervical plate" 87 : 558-563, 2005

19 Goto S., "Anterior surgery in four consecutive technical phases for cervical spondylotic myelopathy" 18 : 1968-1973, 1993

20 Gore DR., "Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients" 9 : 667-671, 1984

21 Garrido BJ., "Adjacent-level cervical ossification after Bryan cervical disc arthroplasty compared with anterior cervical discectomy and fusion" 93 : 1185-1189, 2011

22 Yang JY., "Adjacent level ossification development after anterior cervical fusion without plate fixation" 34 : 30-33, 2009

23 Fuller DA., "A kinematic study of the cervical spine before and after segmental arthrodesis" 23 : 1649-1656, 1998