Liu Jiaming, Xiong Xu, Long Xinhua, Shu Yong, Huang Shanhu, Yang Dong, Liu Zhili
Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University Nanchang 330006, P.R. China.
Int J Clin Exp Med. 2015 Jun 15;8(6):9100-6. eCollection 2015.
A prospective study and a technical note.
Autograft is considered to be the gold standard in achieving optimal fusion in anterior cervical discectomy and fusion (ACDF). In patients with combined postero-anterior cervical procedure, whether the cervical laminae harvested from laminectomy can be used as astructural bone graft in ACDF? Few studies have reported about this.
To describe the clinical and radio graphic outcomes in patients undergoing combined postero-anterior cervical surgery using autologous laminae as bone graft in ACDF.
Twenty-two patients (13 males, 9 females) with cervical spondylotic myelopathy underwent one-level combined postero-anterior procedure with anterior plate fixation from January 2010 to January 2014. All the patients received computed tomography scan before surgery and the heights of the target laminae and the middle intervertebral space were measured. Then, patients underwent combined postero-anterior surgery with laminectomy and ACDF. The structural laminae obtained from laminectomy were used as bone graft in ACDF. The clinical and radiographic outcomes of the patients were analyzed and the effectiveness and safety of the surgery was evaluated.
The average heights of the target laminae and the middle intervertebral space were 11.18±1.05 mm and 5.75±0.58 mm, respectively. Statistical significant difference was found between the heights of the laminae and the space (P<0.001). The mean operative time was 192±37 minutes with an average blood loss volume of 235±71 ml. All patients were followed up and the average follow-up period was 17.5±3.1 months. All patients had immediate postoperative resolution of symptoms and radiographic evidence of solid fusion 3 months later. Postoperatively, excellent results were reported in 62.5%, good results in 18.8%, and fair results in 18.8% of the patients according to Odom's criteria. Visual analog scale score of the neck and extremities pain was significantly decreased after the surgery (P=0.014). The average preoperative and postoperative lordosis angles of the cervical spine were24.42°±13.84° and 32.91°±7.79°, and the difference was significant (P<0.01). Little loss of the angle was noted at final follow-up (32.91°±7.79° VS 29.30±7.88, P=0.51). Anterior intervertebral space height was significantly increased (P<0.001) after the surgery and a little declined at final follow-up (P=0.43). No intraoperative complication was noted in the patients and three patients got self-limiting dysphagia postoperatively, who recovered spontaneously.
In patients undergoing combined postero-anterior cervical surgery, structural autograft harvested from the laminae provides an alternative to anterior iliac crest grafting.
一项前瞻性研究及技术说明。
自体骨移植被认为是颈椎前路椎间盘切除融合术（ACDF）实现最佳融合的金标准。在接受前后联合颈椎手术的患者中，从椎板切除术中获取的颈椎椎板能否用作ACDF的结构性骨移植材料？鲜有研究报道。
描述在前后联合颈椎手术中使用自体椎板作为ACDF骨移植材料的患者的临床及影像学结果。
2010年1月至2014年1月，22例脊髓型颈椎病患者（男13例，女9例）接受了一期前后联合手术及前路钢板固定。所有患者术前均行计算机断层扫描，测量目标椎板及中间椎间隙的高度。然后，患者接受前后联合手术，包括椎板切除术及ACDF。从椎板切除术中获取的结构性椎板用作ACDF的骨移植材料。分析患者的临床及影像学结果，评估手术的有效性和安全性。
目标椎板及中间椎间隙的平均高度分别为11.18±1.05mm和5.75±0.58mm。椎板高度与椎间隙高度之间存在统计学显著差异（P<0.001）。平均手术时间为192±37分钟，平均失血量为235±71ml。所有患者均获随访，平均随访时间为17.5±3.1个月。所有患者术后症状立即缓解，3个月后有影像学证据显示融合牢固。根据奥多姆标准，术后62.5%的患者结果为优，18.8%为良，18.8%为中平。术后颈部及四肢疼痛的视觉模拟评分显著降低（P=0.014）。颈椎术前及术后的平均前凸角分别为24.42°±13.84°和32.91°±7.79°，差异有统计学意义（P<0.01）。末次随访时角度丢失较少（32.91°±7.79°对29.30±7.88，P=0.51）。术后前路椎间隙高度显著增加（P<0.001），末次随访时略有下降（P=0.43）。患者术中无并发症发生，3例患者术后出现自限性吞咽困难，均自行恢复。
在接受前后联合颈椎手术的患者中，从椎板获取的结构性自体骨移植是髂嵴前路移植的一种替代方法。
