Park Jong-Hwa, Hyun Seung-Jae, Lee Chang-Hyun, Kim Ki-Jeong, Yeom Jin S, Jahng Tae-Ahn, Kim Hyun-Jib
Departments of *Neurosurgery†Orthopedic Surgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
Clin Spine Surg. 2016 Feb;29(1):E43-8. doi: 10.1097/BSD.0000000000000111.
A retrospective case-control study.
It has been reported that adjacent segment ossification development (ASOD) commonly occurs after anterior cervical arthrodesis.
The aim of this study was to compare the efficacy of the short plate and oblique screw trajectory with the traditional long plate and parallel screw trajectory by investigating the incidence of ASOD and graft subsidence.
We retrospectively reviewed the patients who underwent single-level anterior cervical discectomy and fusion (ACDF) with plate augmentation in our institute between June 2003 and August 2011. The patients were divided into 2 groups according to the plating technique, which was determined by the distances between the tips of the plate and the cranial and caudal adjacent endplates (plate-to-endplate distance, PED). Group L included the patients with a long plate (PED shorter than 5 mm), and group S contained the patients with a short plate (PED longer than 5 mm). Vertebral body height, distribution of ACDF level, incidence of cranial and caudal ASOD, ASOD grade, screw-to-endplate angle, vertebral body diameter, screw length, screw-to-body ratio, disk space height, subsidence, and cervical range of motion were measured and compared between the 2 groups.
The incidences of both cranial and caudal ASOD at least 2 years after surgery in group S were significantly lower than in group L (17.6% vs. 53.8%, P=0.001 and 31.4% vs. 65.4%, P=0.004, respectively). The incidence of severe ASOD at the caudal adjacent disk space was significantly lower in group S (2.0% vs. 23.0%, P=0.002). The incidence of the subsidence was significantly lower in group S (2.0% vs. 25.9, P=0.001). Changes in the cervical range of motion showed no significant differences regardless of group, ASOD, and graft subsidence.
Techniques using a short plate with an oblique screw trajectory resulted in significantly reduced incidence and severity of ASOD and prevented graft subsidence.
一项回顾性病例对照研究。
据报道，颈椎前路融合术后相邻节段骨化发展（ASOD）较为常见。
本研究旨在通过调查ASOD的发生率和植骨沉降情况，比较短钢板和斜螺钉轨迹与传统长钢板和平行螺钉轨迹的疗效。
我们回顾性分析了2003年6月至2011年8月在我院接受单节段颈椎前路椎间盘切除融合术（ACDF）并使用钢板增强的患者。根据钢板技术将患者分为两组，这由钢板尖端与头侧和尾侧相邻终板之间的距离（钢板至终板距离，PED）决定。L组包括使用长钢板（PED短于5mm）的患者，S组包括使用短钢板（PED长于5mm）的患者。测量并比较两组之间的椎体高度、ACDF节段分布、头侧和尾侧ASOD的发生率、ASOD分级、螺钉至终板角度（螺钉终板角）、椎体直径、螺钉长度、螺钉与椎体比例、椎间盘间隙高度、沉降以及颈椎活动范围。
S组术后至少2年时头侧和尾侧ASOD的发生率均显著低于L组（分别为17.6%对53.8%，P = 0.001；31.4%对65.4%，P = 0.004）。S组尾侧相邻椎间盘间隙严重ASOD的发生率显著更低（2.0%对23.0%，P = 0.002）。S组沉降的发生率显著更低（2.0%对25.9，P = 0.001）。无论组别、ASOD和植骨沉降情况如何，颈椎活动范围的变化均无显著差异。
采用短钢板和斜螺钉轨迹的技术可显著降低ASOD的发生率和严重程度，并防止植骨沉降。
