Koehler Stefan, Raslan Furat, Stetter Christian, Rueckriegel Stefan Mark, Ernestus Ralf-Ingo, Westermaier Thomas
Department of Neurosurgery, University Hospital Wuerzburg; and.
Department of Neurosurgery, Klinikum Hohe Warte, Bayreuth, Germany.
J Neurosurg Spine. 2016 Feb;24(2):309-314. doi: 10.3171/2015.5.SPINE14887. Epub 2015 Oct 13.
OBJECT Anterior cervical corpectomy with fusion has become the most widely used procedure for the treatment of multilevel cervical stenosis. Although an autologous bone graft is the gold standard for vertebral replacement after corpectomy, industrial implants have become popular because they result in no donor-site morbidity. In this study, the authors compared clinical and radiological results of autologous iliac grafts versus those of bone-filled polyetherketoneketone (PEKK) cage implants. METHODS The clinical and radiological data of 46 patients with degenerative multilevel cervical stenosis and who underwent 1- or 2-level anterior median corpectomy between 2004 and 2012 were analyzed. The patients in Group 1 were treated with vertebral replacement with an autologous iliac graft, and those in Group 2 were treated with a PEKK cage implant. Each patient also underwent osteosynthesis with an anterior plate-screw system. Visual analog scale (VAS) and European Myelopathy Scale scores, loss of height and regional cervical lordosis angle, and complication rates of the 2 groups were compared. RESULTS The mean follow-up time was 20 months. In both groups, the VAS and European Myelopathy Scale scores improved significantly. The loss of height was 3.7% in patients with iliac grafts and 5.3% in patients with PEKK implants. The rates of osseous fusion were similar in Groups 1 and 2 (94.7% and 91.3%, respectively). At the end of the follow-up period, none of the patients complained about donor-site pain. One patient in Group 1 suffered a fracture of the iliac bone that required osteosynthesis. Four patients in Group 2 had to receive revision surgery for cage and/or plate-screw dislocation and new neurological deficit or intractable pain. CONCLUSIONS Preoperative pain and radicularand myelopathic symptoms improve after decompression irrespective of the material used for vertebral replacement. The use of PEKK cages for vertebral replacement seems to result in a higher risk of implant-related complications. A prospective randomized study is necessary to supply evidence for the use of autografts and artificial implants after anterior cervical corpectomy with fusion.
目的 颈椎前路椎体次全切除融合术已成为治疗多节段颈椎管狭窄最常用的手术方法。尽管自体骨移植是椎体次全切除术后椎体置换的金标准，但工业植入物因其不会导致供区并发症而受到欢迎。在本研究中，作者比较了自体髂骨移植与填充骨的聚醚酮酮（PEKK）椎间融合器植入的临床和影像学结果。方法 分析2004年至2012年间46例退行性多节段颈椎管狭窄患者行1或2节段前路椎体次全切除术的临床和影像学资料。第1组患者采用自体髂骨移植进行椎体置换，第2组患者采用PEKK椎间融合器植入治疗。每位患者均接受前路钢板螺钉系统内固定。比较两组患者的视觉模拟评分（VAS）、欧洲脊髓病量表评分、椎体高度丢失和颈椎节段前凸角，以及并发症发生率。结果 平均随访时间为20个月。两组患者的VAS和欧洲脊髓病量表评分均显著改善。髂骨移植患者的椎体高度丢失为3.7%，PEKK植入患者为5.3%。第1组和第2组的骨融合率相似（分别为94.7%和91.3%）。随访期末，无患者主诉供区疼痛。第1组1例患者髂骨骨折，需要进行内固定。第2组4例患者因椎间融合器和/或钢板螺钉移位以及新出现的神经功能缺损或顽固性疼痛而接受翻修手术。结论 减压术后，无论椎体置换使用何种材料，术前疼痛以及神经根和脊髓病症状均会改善。使用PEKK椎间融合器进行椎体置换似乎会导致与植入物相关的并发症风险更高。有必要进行一项前瞻性随机研究，为颈椎前路椎体次全切除融合术后自体骨移植和人工植入物的使用提供证据。
