Singh D, Sinha S, Singh H, Jagetia A, Gupta S, Gangoo P, Tandon M
Department of Neurosurgery, G B Pant Hospital, New Delhi, India.
Minim Invasive Neurosurg. 2011 Aug;54(4):172-8. doi: 10.1055/s-0031-1284399. Epub 2011 Sep 15.
Anterior cervical discoidectomy with or without fusion is a well established surgical remedy for cervical prolapsed intervertebral disc (PIVD) disease. If fusion is done by an iliac bone graft then internal fixation is commonly used to keep the graft in position. This study was conducted to determine the efficacy and tolerability of shape memory alloys, especially NiTi (nickel titanium) clips in the stabilization of grafts following anterior cervical discoidectomy.
133 NiTi clips were applied in 119 patients between January 2002 and December 2008. The patients age ranged from 38-60 years. There were 66 male and 53 females. Various indications for fixation of the spine included degenerated cervical spondylosis with single level PIVD (105) and two level PIVD in 14 patients. The cine mode fluoroscopy confirmed the perioperative correct placement of grafts and clips in all the patients. Follow-up ranged from 2 to 8 years (mean: 4.6 years).
Single level discoidectomy was performed in 105 patients and two level disc removal was done in 14 patients. A single NiTi clip was applied in all the cases except for 14 cases of two level PIVD. No procedural complication or adverse reaction to the clip was noted. There was no movement at the operated level in dynamic lateral view X-ray of cervical spine at the 1st postoperative day as well as on follow-up. Graft extrusion was seen in one patient on the 2nd day after surgery and was reoperated. Bony fusion occurred in all patients after 9 - 12 months of surgery. There was no incidence of breakage or dislodgement of the clip from the site where it was inserted. No artifact was noted in cervical MRI done in 33 patients.
NiTi clips are a simple alternative for cervical spine stabilization after discoidectomy. Their insertion is simple, minimally invasive, does not require any special set of instruments and they are much more economical than other established methods of treatment. These clips are accepted well by human tissue and do not interfere with MRI.
颈椎间盘切除并融合或不融合是治疗颈椎间盘突出症（PIVD）的一种成熟的手术方法。如果采用髂骨移植进行融合，通常会使用内固定来保持移植骨的位置。本研究旨在确定形状记忆合金，特别是镍钛（NiTi）夹在前路颈椎间盘切除术后移植骨稳定中的疗效和耐受性。
2002年1月至2008年12月期间，119例患者应用了133个NiTi夹。患者年龄在38 - 60岁之间。男性66例，女性53例。脊柱固定的各种适应证包括单节段PIVD的退变性颈椎病（105例）和14例双节段PIVD。动态荧光透视证实所有患者术中移植骨和夹子放置正确。随访时间为2至8年（平均4.6年）。
105例患者进行了单节段椎间盘切除术，14例患者进行了双节段椎间盘切除术。除14例双节段PIVD外，所有病例均应用单个NiTi夹。未观察到手术并发症或对夹子的不良反应。术后第1天及随访时颈椎动态侧位X线片显示手术节段无活动。1例患者术后第2天出现移植骨挤出，再次手术。所有患者术后9至12个月均发生骨融合。夹子在插入部位未发生断裂或移位。33例患者的颈椎MRI未发现伪影。
NiTi夹是椎间盘切除术后颈椎稳定的一种简单替代方法。其插入简单、微创，不需要任何特殊器械，且比其他既定治疗方法经济得多。这些夹子被人体组织很好地接受，不干扰MRI。
