Schulz Chris, Mauer Uwe Max, Mathieu René
Neurochirurgie, Bundeswehrkrankenhaus Ulm.
Z Orthop Unfall. 2017 Apr;155(2):201-208. doi: 10.1055/s-0042-118717. Epub 2017 Jan 10.
Anterior cervical corpectomy and fusion (ACCF) has become a standard procedure for patients with spondylotic myelopathy due to multisegmental stenosis of the cervical canal. Beside the fusion technique using autogenous bone grafts, synthetic cages have been increasingly used in recent years. Published information on the clinical and radiological results of different cage materials for ACCF is still limited. The study presented here is the largest series to date reporting clinical and radiological outcomes and complication rates after one- to three-level ACCF using structural polyetheretherketone (PEEK) or titanium cages augmented by anterior plate-screw osteosynthesis. Retrospective comparative study on 126 patients after cage ACCF using modular PEEK (n = 101) or distractable titanium (n = 25) cages with a minimum follow-up of 6 months. The numbers of hardware failures and implant-related surgical revisions were determined. The rate of subsidence and fusion and the course of lordotic alignment (segmental and regional Cobb's angles) were analysed. Neck Disability Index (NDI) and European Myelopathy Score (EMS) were assessed. Significantly greater number of screw and cage complications were detected in the titanium cage group (36 vs. 7.9 % and 64 vs. 36.6 %, respectively). Non-significant trend to a higher rate of implant related revision rate in the titanium cage group (16 vs. 2.97 %). Significantly greater rate of grade I or II fusion in the PEEK cage group after 6 months (82 vs. 52 %). NDI, EMS and lordotic alignment improved significantly in both groups. There were neither significant differences between the two groups nor significant correlations between these clinico-radiological parameters and the cage material. Partial correlations performed with control of parameters showing inhomogenous distribution (patient age, fusion distance, rate of multilevel corpectomy and the rate of intraoperative segmental overdistraction) showed no significant correlations for any of the clinical or radiological outcome parameters and the complications or revisions to the cage material. Cages are a safe and effective alternative to autogenous bone graft for ACCF. A significant improvement in clinical and radiological parameters can be achieved with both titanium and PEEK implants. Significant differences between the two cage material groups or significant correlations of clinico-radiological outcome and cage material were not proven. Moreover there is no evidence in the literature for clinical advantages of one special cage material, to date. Therefore further prospective randomised evaluation of different fusion techniques in ACCF is still necessary.
颈椎前路椎体次全切除融合术（ACCF）已成为因颈椎管多节段狭窄导致脊髓型颈椎病患者的标准手术。除了使用自体骨移植的融合技术外，近年来合成椎间融合器的使用也越来越多。关于不同椎间融合器材料用于ACCF的临床和影像学结果的公开信息仍然有限。本文介绍的这项研究是迄今为止最大规模的系列研究，报告了使用结构性聚醚醚酮（PEEK）或钛制椎间融合器并辅以钢板螺钉前路骨合成技术进行一至三节段ACCF后的临床、影像学结果及并发症发生率。对126例行椎间融合器ACCF的患者进行回顾性比较研究，其中使用模块化PEEK椎间融合器的患者有101例，使用可撑开钛制椎间融合器的患者有25例，随访时间至少6个月。确定了内固定失败和与植入物相关的手术翻修次数。分析了下沉和融合率以及前凸对线情况（节段性和区域性Cobb角）。评估了颈部功能障碍指数（NDI）和欧洲脊髓病评分（EMS）。在钛制椎间融合器组中检测到的螺钉和椎间融合器并发症数量明显更多（分别为36%对7.9%和64%对36.6%）。钛制椎间融合器组中与植入物相关的翻修率有更高的非显著趋势（16%对2.97%）。6个月后，PEEK椎间融合器组的I级或II级融合率明显更高（82%对52%）。两组的NDI、EMS和前凸对线均有显著改善。两组之间没有显著差异，这些临床影像学参数与椎间融合器材料之间也没有显著相关性。在控制显示分布不均一的参数（患者年龄、融合节段数、多节段椎体次全切除率和术中节段性过度撑开率）后进行的偏相关分析显示，任何临床或影像学结果参数与椎间融合器材料的并发症或翻修之间均无显著相关性。椎间融合器是ACCF中自体骨移植的一种安全有效的替代方法。钛制和PEEK植入物均可显著改善临床和影像学参数。未证实两种椎间融合器材料组之间存在显著差异，也未证实临床影像学结果与椎间融合器材料之间存在显著相关性。此外，迄今为止，文献中没有证据表明一种特殊的椎间融合器材料具有临床优势。因此，仍有必要对ACCF中不同的融合技术进行进一步的前瞻性随机评估。
