Yu Jaecheon, Ha Yoon, Shin Jun Jae, Oh Jae Keun, Lee Chang Kyu, Kim Keung Nyun, Yoon Do Heum
a Department of Neurosurgery , Sanggye Paik Hospital, Inje University College of Medicine , Seoul , Korea.
b Department of Neurosurgery , Yonsei University College of Medicine , Seoul , Korea.
Br J Neurosurg. 2018 Apr;32(2):188-195. doi: 10.1080/02688697.2017.1394980. Epub 2017 Oct 26.
To evaluate the efficacy of plate fixation on cervical alignment after anterior cervical discectomy and fusion (ACDF) using a stand-alone cage (ACDF-CA), compared to ACDF performed using a cage and plate fixation (ACDF-CP) and ACDF using autologous iliac bone graft and plate fixation (ACDF-AP), for the treatment of one- or two-level cervical degenerative disease. A second objective was to assess the clinical and radiological outcomes between the groups.
A total of 247 patients underwent ACDF and were divided into three groups: those who underwent ACDF-CA (n = 76), ACDF-CP (n = 82) or ACDF-AP (n = 89). Fusion rate and time-to-fusion, global cervical and segmental angle, fused segment height, subsidence rate, and clinical outcomes, were measured using the visual analogue scale (VAS), Oswestry Neck Disability Index (NDI), and Robinson's criteria, assessed preoperatively, immediately postoperatively, and at least 24 months, postoperatively.
ACDF-AP was associated with the shortest mean time-to-fusion, followed by ACDF-CP and ACDF-CA. Compared to the preoperative status, the fused segment height and segmental angle increased in all groups immediately postoperatively, being well-maintained in patients who underwent ACDF-AP, while decreasing in those who underwent ACDF-CP and ACDF-CA procedures. Global cervical lordosis increased with ACDF-AP, but decreased immediately postoperatively with ACDF-CP and ACDF-CA, and at the final follow-up. Univariate analysis confirmed that a change in fused segment height was positively associated with a change in both segmental and global cervical angles. Clinical outcomes, namely VAS and NDI scores, as well as Robinson's criteria, were comparable among the three techniques.
Supplementation with plate fixation, especially using autologous iliac bone graft, is beneficial for maintaining the fused segment height and cervical spine curvature, as well as reducing time-to-fusion and subsidence rate.
评估单独使用椎间融合器（ACDF-CA）进行颈椎前路椎间盘切除融合术（ACDF）后钢板固定对颈椎对线的疗效，并与使用椎间融合器和钢板固定（ACDF-CP）以及使用自体髂骨移植和钢板固定（ACDF-AP）进行的ACDF治疗一或两节段颈椎退行性疾病的疗效进行比较。第二个目的是评估各组之间的临床和影像学结果。
共有247例患者接受了ACDF，并分为三组：接受ACDF-CA的患者（n = 76）、接受ACDF-CP的患者（n = 82）或接受ACDF-AP的患者（n = 89）。使用视觉模拟量表（VAS）、Oswestry颈部功能障碍指数（NDI）和罗宾逊标准，在术前、术后即刻以及术后至少24个月测量融合率和融合时间、颈椎整体和节段角度、融合节段高度、下沉率以及临床结果。
ACDF-AP的平均融合时间最短，其次是ACDF-CP和ACDF-CA。与术前状态相比，所有组术后即刻融合节段高度和节段角度均增加，接受ACDF-AP的患者中保持良好，而接受ACDF-CP和ACDF-CA手术的患者中则下降。ACDF-AP使颈椎前凸增加，但ACDF-CP和ACDF-CA术后即刻以及末次随访时颈椎前凸下降。单因素分析证实，融合节段高度的变化与节段和颈椎整体角度的变化呈正相关。三种技术的临床结果，即VAS和NDI评分以及罗宾逊标准，具有可比性。
补充钢板固定，尤其是使用自体髂骨移植，有利于维持融合节段高度和颈椎曲度，以及缩短融合时间和降低下沉率。
