Ha Kee-Yong, Shin Jae-Hyuk, Kim Ki-Won, Na Ki-Ho
Department of Orthopaedic Surgery, Kang-Nam St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.
Spine (Phila Pa 1976). 2007 Aug 1;32(17):1856-64. doi: 10.1097/BRS.0b013e318108b804.
A retrospective clinical study.
To assess the results of anterior strut grafting and the loss of the reduction in anterior interbody fusion and anterior interbody fusion combined with posterior instrumental fusion in pyogenic spondylodiscitis.
Resorption of the anterior graft is an ominous sign following most anterior surgery. Thus, additional posterior instrumentation has been used to prevent collapse of the anterior graft. However, its effect is controversial, and few studies have examined the fate of the anterior strut graft.
Twenty-four consecutive patients underwent surgical treatment for pyogenic spondylodiscitis. The patients were divided into Group I (anterior interbody fusion) and Group II (anterior interbody fusion + posterior instrumented fusion). The sagittal angle, intervertebral height, and complications relating to the anterior graft were compared.
Solid bone fusion was achieved in 23 (95.8%) patients. The sagittal angle and the intervertebral height were similar in Groups I and II (P = 0.61, P = 0.89, respectively). In Groups I and II, the postoperative sagittal angle was maintained until 1 month after surgery (P > 0.05), but it decreased significantly by 3 months after surgery (P < 0.05). In Groups I and II, intervertebral height correction was maintained until 1 month after surgery (P > 0.05), but by 3 months after surgery, it had collapsed significantly (P < 0.05). Subsidence of the graft occurred through the damaged endplate. Group I included 1 case of graft dislodgement necessitating revision; there were no such cases in Group II. There were no recurrences of infection in either group.
Reduction of intervertebral height and loss of sagittal profile occurred in both groups. Complications relating to the bone graft were more common in Group I than in Group II. Despite loss of correction, both groups had a high fusion rate without recurrence of infection. The reduction of intervertebral graft height appears to be the result of destruction of the endplate either due to surgical debridement or the infective process.
一项回顾性临床研究。
评估前路支撑植骨以及前路椎间融合术单独应用与联合后路器械融合术治疗化脓性脊椎间盘炎时前路椎间融合的复位丢失情况。
多数前路手术后，前路植骨吸收是一个不祥之兆。因此，已采用额外的后路器械辅助来防止前路植骨塌陷。然而，其效果存在争议，且很少有研究探讨前路支撑植骨的转归。
连续24例化脓性脊椎间盘炎患者接受了手术治疗。患者被分为I组（前路椎间融合术）和II组（前路椎间融合术 + 后路器械融合术）。比较矢状角、椎间高度以及与前路植骨相关的并发症。
23例（95.8%）患者实现了坚固的骨融合。I组和II组的矢状角和椎间高度相似（分别为P = 0.61，P = 0.89）。在I组和II组中，术后矢状角在术后1个月时保持稳定（P > 0.05），但在术后3个月时显著减小（P < 0.05）。在I组和II组中，椎间高度矫正在术后1个月时保持稳定（P > 0.05），但在术后3个月时已明显塌陷（P < 0.05）。植骨沉降通过受损的终板发生。I组有1例植骨移位需要翻修；II组无此类病例。两组均无感染复发。
两组均出现了椎间高度降低和矢状面形态丢失。I组与植骨相关的并发症比II组更常见。尽管矫正丢失，但两组均有较高的融合率且无感染复发。椎间植骨高度降低似乎是手术清创或感染过程导致终板破坏的结果。
