Janssen M E, Lam C, Beckham R
Center for Spinal Disorders, P.C., Denver, Colorado 80229, USA.
Eur Spine J. 2001 Oct;10 Suppl 2(Suppl 2):S158-68. doi: 10.1007/s005860100292.
Interbody lumbar fusions provide a proven logical solution to diseases of the intervertebral discs by eliminating motion of the segment. Historically, there are many techniques to achieve spinal fusion in the lumbar spine. These include anterior, posterior, and foramenal approaches, often in combination with various internal fixation devices. The surgeon's choice of the approach and mechanical or biological implant is dependent on the patient's specific pathology and anatomy, in addition to the experience and training of the surgeon in similar conditions. In the past decade, new mechanical spine implants/spacers have been designed to provide restoration of disc height and improve stabilization of the spine. The ability to radiographically assess the "biology" of bone incorporation in these mechanical (metal) spacers has become a significant limitation. The femoral ring allograft (FRA) and the posterior lumbar interbody fusion (PLIF) spacers have been developed as "biological cages" that permit restoration of the anterior column with machined allograft bone biological cages. Test results demonstrate that the FRA and PLIF spacers have a compressive strength of over 25,000 N. The pyramid-shaped teeth on the surfaces and the geometry of the implant increase the resistance to expulsion at clinically relevant loads (1053 and 1236 N). The technique of anterior column reconstruction with both the FRA and the PLIF biological cages have been previously reported. Clinical outcomes and experience with the FRA spacer (137 patients) and the PLIF spacer (13 patients) were reported on and did not reveal any evidence of bone cage resorption or infectious inflammatory process. There was clinical migration with one PLIF spacer, which was later revised with an anterior approach and a FRA spacer. The radiographic outcomes demonstrated that 94% arthrodesis was achieved with the biological spacer and additional posterior instrumentation. The clinical success of every spine fusion procedure is dependent on many factors such as the extent of the instability, the pathology, type of graft used, the patient's pathology/anatomy and lifestyle.
腰椎椎间融合术通过消除节段运动，为椎间盘疾病提供了一种经证实的合理解决方案。从历史上看，有许多技术可实现腰椎的脊柱融合。这些技术包括前路、后路和椎间孔入路，通常还会结合各种内固定装置。外科医生对手术入路以及机械或生物植入物的选择，除了取决于外科医生在类似情况下的经验和培训外，还取决于患者的具体病理情况和解剖结构。在过去十年中，新型机械脊柱植入物/间隔器已被设计出来，以恢复椎间盘高度并改善脊柱稳定性。对这些机械（金属）间隔器中骨融合的“生物学”进行影像学评估的能力已成为一个重大限制。股骨环同种异体骨（FRA）和后路腰椎椎间融合（PLIF）间隔器已被开发为“生物融合器”，可通过加工同种异体骨生物融合器来恢复前柱。测试结果表明，FRA和PLIF间隔器的抗压强度超过25000 N。植入物表面的金字塔形齿以及其几何形状增加了在临床相关负荷（1053和1236 N）下的抗脱出能力。先前已报道了使用FRA和PLIF生物融合器进行前柱重建的技术。报告了FRA间隔器（137例患者）和PLIF间隔器（13例患者）的临床结果和经验，未发现任何骨融合器吸收或感染性炎症过程的证据。有一个PLIF间隔器出现了临床移位，后来通过前路手术和FRA间隔器进行了翻修。影像学结果表明，使用生物间隔器和额外的后路内固定可实现94%的融合。每个脊柱融合手术的临床成功取决于许多因素，如不稳定的程度、病理情况、所用移植物的类型、患者的病理/解剖结构和生活方式。
