Suchomel Petr, Barsa Pavel, Buchvald Pavel, Svobodnik Adam, Vanickova Eva
Department of Neurosurgery, Hospital Liberec, Husova 10, 46063 Liberec, Czech Republic.
Eur Spine J. 2004 Oct;13(6):510-5. doi: 10.1007/s00586-003-0667-z. Epub 2004 Mar 20.
The purpose of this prospective semi-randomised comparative study was to compare fusion rates, course of fusion, and occurrence of collapse and subsidence of autologous and allogenic bone grafts in instrumented anterior cervical fusion. The number of fused levels and the smoking status were investigated as potential factors influencing the bone-healing process. No similar prospective study on instrumented anterior cervical discectomy and fusion was found in the literature.
Seventy-nine consecutive patients were operated on using the Smith-Robinson technique with a single instrumentation system at one or two levels. Seventy-six cadaverous fibular bone grafts and 37 autologous iliac-crest bone grafts were inserted. All patients were followed up for at least 2 years.
The radiographs obtained during the follow-up were analysed, and showed no statistical difference in fusion and collapse rate between autografts and allografts. Allografts showed significantly longer time to union. No case of graft migration was observed. No difference was found between fusion and collapse rate with respect to the number of fused levels in general, but greater time to union was seen in two-level fusions. When one- and two-level subgroups were compared, there was no evidence of any significant difference in fusion or collapse rates between autografts and allografts, and the healing process took longer in allogenic grafts. Smoking status did not alter any of the fusion or collapse rates, or the course of bone fusion.
This study demonstrates that allografts are suitable substitutes for autografts in instrumented ACDF. Prolonged time to union observed in allogenic bone grafts does not seem to be an important factor in instrumented procedures. Two-level grafting does not imply a significantly lower fusion rate, but longer time to union can be expected than with single-level instrumented procedures in both allograft and autograft subgroups. Our relatively small number of patients may not have been sufficient to decipher significant differences between smokers and non-smokers in the rate or course of fusion as previously reported.
本前瞻性半随机对照研究旨在比较在颈椎前路融合内固定术中自体骨移植和同种异体骨移植的融合率、融合过程以及塌陷和下沉的发生率。研究融合节段数量和吸烟状况作为影响骨愈合过程的潜在因素。文献中未发现类似的关于颈椎前路椎间盘切除融合内固定术的前瞻性研究。
连续79例患者采用Smith-Robinson技术在一个或两个节段使用单一内固定系统进行手术。植入76块尸体腓骨骨移植和37块自体髂嵴骨移植。所有患者均随访至少2年。
对随访期间获得的X线片进行分析，结果显示自体骨移植和同种异体骨移植在融合率和塌陷率方面无统计学差异。同种异体骨移植显示出明显更长的愈合时间。未观察到移植骨移位病例。总体而言，融合率和塌陷率在融合节段数量方面无差异，但两节段融合的愈合时间更长。当对单节段和双节段亚组进行比较时，自体骨移植和同种异体骨移植在融合率或塌陷率方面均无显著差异的证据，且同种异体骨移植的愈合过程更长。吸烟状况未改变任何融合率或塌陷率，也未改变骨融合过程。
本研究表明，在颈椎前路椎间盘切除融合内固定术中，同种异体骨移植是自体骨移植的合适替代物。同种异体骨移植中观察到的愈合时间延长在该内固定手术中似乎不是一个重要因素。两节段移植并不意味着融合率显著降低，但在同种异体骨移植和自体骨移植亚组中，与单节段内固定手术相比，预计愈合时间更长。我们相对较少的患者数量可能不足以解读如先前报道的吸烟者和非吸烟者在融合率或融合过程方面的显著差异。
