Lee Chang-Hyun, Hyun Seung-Jae, Kim Min Jeong, Yeom Jin S, Kim Wook Ha, Kim Ki-Jeong, Jahng Tae-Ahn, Kim Hyun-Jib, Yoon Sang Hoon
Departments of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.
J Spinal Disord Tech. 2013 Apr;26(2):112-8. doi: 10.1097/BSD.0b013e318274148e.
A retrospective cohort-nested longitudinal study.
To evaluate radiologic and clinically functional outcomes after single-level anterior cervical discectomy and fusion (ACDF) using 3 different fusion construct systems applying an accurate and reliable methodology.
ACDF is an established procedure that uses 3 different fusion construct systems: cage alone (CA), iliac tricortical bone block with plate (IP), and cage with plate construct (CP). The outcome of a previous study is quite different and did not correlate with experimental studies.
ACDF was performed on 158 patients (90 male and 68 female), who were followed up for >12 months. The patients were divided into the following 3 treatment groups: CA, IP, and CP. Factors related to outcome were also evaluated. Fusion rate, subsidence rate, and cervical angles were used to measure radiologic outcome. The Odom criteria and the visual analog scale were used to evaluate the clinical outcome.
The fusion rate was higher for patients in the IP (87.1%) and CP (79.5%) groups than for those in the CA group (63.2%) after 12 months of follow-up (P=0.019). The subsidence rate was lower for patients in the IP (28.1%) and CP (38.5%) groups than for those in the CA group (58.6%) (P=0.010). Subsidence occurred for the anterior height regardless of constructs. Radiating arm pain showed greater relief in the CP group than in the CA group (P=0.015). It improved more in the CP group than in the IP group, but the differences were not statistically significant (P=0.388). Other clinical outcomes did not show significant differences.
The trend of excellent radiologic outcome was observed for IP≥CP>CA. Plating may play a key role in the support of anterior height. As a result, plating prevents segmental kyphosis and subsidence and promotes bone fusion. Although the overall clinical outcomes were not different among the 3 groups, except for arm pain, more favorable trends regarding clinical outcome were observed for CP≥IP>CA.
一项回顾性队列嵌套纵向研究。
采用准确可靠的方法，评估使用3种不同融合构建系统进行单节段颈椎前路椎间盘切除融合术（ACDF）后的影像学和临床功能结果。
ACDF是一种成熟的手术，使用3种不同的融合构建系统：单纯椎间融合器（CA）、带钢板的髂骨三面皮质骨块（IP）和带钢板的椎间融合器构建（CP）。先前一项研究的结果差异很大，且与实验研究不相关。
对158例患者（90例男性和68例女性）进行了ACDF手术，并对其进行了超过12个月的随访。患者被分为以下3个治疗组：CA组、IP组和CP组。还评估了与结果相关的因素。融合率、下沉率和颈椎角度用于测量影像学结果。采用奥多姆标准和视觉模拟量表评估临床结果。
随访12个月后，IP组（87.1%）和CP组（79.5%）患者的融合率高于CA组（63.2%）（P = 0.019）。IP组（28.1%）和CP组（38.5%）患者的下沉率低于CA组（58.6%）（P = 0.010）。无论采用何种构建方式，前凸高度均出现下沉。CP组放射性手臂疼痛的缓解程度高于CA组（P = 0.015）。CP组的改善程度高于IP组，但差异无统计学意义（P = 0.388）。其他临床结果无显著差异。
观察到IP≥CP>CA的影像学结果良好趋势。钢板在维持前凸高度方面可能起关键作用。因此，钢板可防止节段性后凸和下沉，并促进骨融合。虽然3组之间的总体临床结果无差异，但除手臂疼痛外，CP≥IP>CA在临床结果方面呈现出更有利的趋势。
