Wang J C, McDonough P W, Kanim L E, Endow K K, Delamarter R B
UCLA Department of Orthopaedic Surgery, UCLA School of Medicine, Los Angeles, California 90095-6902, USA.
Spine (Phila Pa 1976). 2001 Mar 15;26(6):643-6; discussion 646-7. doi: 10.1097/00007632-200103150-00015.
A retrospective review of all patients surgically treated by a single surgeon with a three-level anterior cervical discectomy and fusion with and without anterior plate fixation.
To compare the clinical and radiographic success of anterior three-level discectomy and fusion performed with and without anterior cervical plate fixation.
Previous studies of multilevel cervical discectomies and fusions have shown fusion rates to decrease as the number of surgical levels increases. Anterior cervical plate stabilization can provide more stability and may increase fusion rates for multilevel fusions.
Over a 7-year period, 59 patients were treated surgically with a three-level anterior cervical discectomy and fusion by the senior author. Forty patients had cervical plates, whereas 19 had fusions with no plates. These patients were observed for an average of 3.2 years. Clinical and radiographic follow-up data were obtained.
Of the 59 patients, 14 had a pseudarthrosis (7 in each group). The pseudarthrosis rates were 18% (7 of 40) for patients with plating and 37% (7 of 19) for patients with no plating. Although the nonunion rate for unplated fusions was double that of plated fusions, this difference was not statistically significant. There was no statistically significant correlation between pseudarthrosis and gender, age, level of surgery, history of tobacco use, or previous anterior surgery. The fusion rates were improved with the use of a cervical plate. Inferior clinical results were demonstrated in patients with a pseudarthrosis, regardless of the use of a cervical plate.
The addition of plate fixation for three-level anterior cervical discectomy and fusion is a safe procedure and does not result in higher complication rates. In this study, the pseudarthrosis rate was lower for patients with a cervical plate. However, this difference was not statistically significant. Patients treated with cervical plating had overall better results when compared with those of patients treated without cervical plates. Although the use of cervical plates decreased the pseudarthrosis rate, a three-level procedure is still associated with a high nonunion rate, and other strategies to increase fusion rates should be explored.
对由一名外科医生进行手术治疗的所有患者进行回顾性研究，这些患者均接受了三节段颈椎前路椎间盘切除融合术，部分患者使用了前路钢板固定，部分未使用。
比较三节段颈椎前路椎间盘切除融合术在使用和不使用颈椎前路钢板固定情况下的临床及影像学成功率。
既往对多节段颈椎间盘切除融合术的研究表明，随着手术节段数增加，融合率会下降。颈椎前路钢板固定可提供更大稳定性，可能提高多节段融合术的融合率。
在7年时间里，资深作者对59例患者进行了三节段颈椎前路椎间盘切除融合术。其中40例患者使用了颈椎钢板，19例患者未使用钢板进行融合。对这些患者平均观察3.2年。获取了临床及影像学随访数据。
59例患者中，14例出现假关节形成（每组各7例）。使用钢板患者的假关节形成率为18%（40例中的7例），未使用钢板患者的假关节形成率为37%（19例中的7例）。虽然未使用钢板融合的不愈合率是使用钢板融合的两倍，但这种差异无统计学意义。假关节形成与性别、年龄、手术节段、吸烟史或既往前路手术之间无统计学显著相关性。使用颈椎钢板可提高融合率。无论是否使用颈椎钢板，出现假关节形成的患者临床结果均较差。
三节段颈椎前路椎间盘切除融合术加用钢板固定是一种安全的手术，不会导致更高的并发症发生率。在本研究中，使用颈椎钢板的患者假关节形成率较低。然而，这种差异无统计学意义。与未使用颈椎钢板治疗的患者相比，使用颈椎钢板治疗的患者总体结果更好。虽然使用颈椎钢板降低了假关节形成率，但三节段手术仍有较高的不愈合率，应探索其他提高融合率的策略。
