Epstein Nancy E
Clinical Professor of Neurosurgery, The Albert Einstein College of Medicine, Bronx, N.Y. 10451, and Chief of Neurosurgical Spine and Education, Winthrop University Hospital, Mineola, N.Y. 11501.
Surg Neurol Int. 2012;3(Suppl 3):S143-56. doi: 10.4103/2152-7806.98575. Epub 2012 Jul 17.
Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The "gold standard", iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers.
Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the "value-added" of these various constructs (e.g. safety/efficacy, risks/complications, costs).
The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent "post hoc analysis of data from a prospective multicenter trial" (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%.
Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the "value added" of these increasingly expensive graft constructs.
对于脊柱外科医生及其所在机构而言，可用于颈椎前路椎间盘切除/融合术（ACDF）的移植选择已成为一个主要关注点。“金标准”——自体髂骨移植，可能仍是最佳且成本最低的移植选择；值得对其以及替代移植材料/椎间融合器的利弊和成本进行重新评估。
尽管单节段或多节段ACDF使用自体髂骨移植已有数十年，但植入物行业如今提供了多种替代移植材料和椎间融合器装置（如异体移植物、椎间融合器、聚醚醚酮（PEEK）等）。虽然大多数研究聚焦于ACDF后的融合率和临床结果，但很少有研究分析这些不同结构的“附加值”（如安全性/有效性、风险/并发症、成本）。
大多数研究表明，使用自体髂骨移植进行单节段ACDF时（术后6 - 12个月经X线或CT证实），融合率为95% - 100%。尽管许多异体移植物研究同样报出90% - 100%的融合率（仅术后6 - 12个月经X线证实），但最近一项“对一项前瞻性多中心试验数据的事后分析”（Riew KD等人，CSRS摘要，2011年12月；未发表）显示，使用异体移植物时，1年延迟融合率高达55.7%，2年为87%，4年为92%。
与异体移植物、椎间融合器、PEEK或其他移植材料相比，用于单节段或多节段ACDF的自体髂骨移植具有最高的融合率、最低的并发症发生率以及显著更低的成本。随着脊柱外科医生和机构对成本的意识增强，我们将不得不考虑这些日益昂贵的移植结构的“附加值”。
