Chin Kingsley R, Pencle Fabio J R, Seale Jason A, Valdivia Juan M
Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL 33431, United States.
Less Exposure Surgery Society, Malden, MA 02148, United States.
World J Orthop. 2017 Oct 18;8(10):770-776. doi: 10.5312/wjo.v8.i10.770.
To assess use of demineralized bone matrix (DBM) use in anterior cervical discectomy and fusion (ACDF) in outpatient setting.
One hundred and forty-five patients with prospectively collected data undergoing single and two level ACDF with DBM packed within and anterior to polyetheretherketone (PEEK) cages. Two groups created, Group 1 (75) outpatients and control Group 2 (70) hospital patients. Prevertebral soft tissue swelling (PVSTS) was measured anterior to C2 and C6 on plain lateral cervical radiographs preoperatively and one week postoperatively and fusion assessed at two years.
There was no intergroup significance between preoperative and postoperative visual analogue scales (VAS) and neck disability index (NDI) scores between Group 1 and 2. Mean preoperative PVSTS in Group 1 was 4.7 ± 0.2 mm at C2 level and 11.1 ± 0.5 at C6 level compared to Group 2 mean PVSTS of 4.5 ± 0.5 mm and 12.8 ± 0.5, = 0.172 and 0.127 respectively. There was no radiographic or clinical evidence of adverse reaction noted. In Group 1 mean postoperative PVSTS was 5.5 ± 0.4 mm at C2 and 14.9 ± 0.6 mm at C6 compared Group 2 mean PVSTS was 4.9 ± 0.3 mm at C2 and 14.8 ± 0.5 mm at C6, = 0.212 and 0.946 respectively. No significant increase in prevertebral soft tissue space at C2 and C6 level demonstrated.
ACDF with adjunct DBM packed PEEK cages showed a statistical significant intragroup improvement in VAS neck pain scores and NDI scores ( = 0.001). There were no reported serious patient complications; post-operative radiographs demonstrated no significant difference in prevertebral space. We conclude that ACDF with DBM-packed PEEK cages can be safely done in an ASC with satisfactory outcomes.
评估在门诊环境下脱矿骨基质（DBM）在前路颈椎间盘切除融合术（ACDF）中的应用。
145例患者前瞻性收集数据，接受单节段和双节段ACDF，DBM填充于聚醚醚酮（PEEK）椎间融合器内及前方。分为两组，第1组（75例）为门诊患者，对照组第2组（70例）为住院患者。术前及术后1周在颈椎侧位X线片上测量C2和C6前方的椎前软组织肿胀（PVSTS），并在两年时评估融合情况。
第1组和第2组术前和术后视觉模拟量表（VAS）及颈部功能障碍指数（NDI）评分组间无显著差异。第1组术前C2水平平均PVSTS为4.7±0.2mm，C6水平为11.1±0.5mm，而第2组平均PVSTS分别为4.5±0.5mm和12.8±0.5mm，P分别为0.172和0.127。未观察到影像学或临床不良反应证据。第1组术后C2平均PVSTS为5.5±0.4mm，C6为14.9±0.6mm，相比之下第2组C2平均PVSTS为4.9±0.3mm，C6为14.8±0.5mm，P分别为0.212和0.946。C2和C6水平椎前软组织间隙无显著增加。
使用填充有辅助DBM的PEEK椎间融合器的ACDF在组内VAS颈部疼痛评分和NDI评分方面有统计学显著改善（P = 0.001）。未报告严重患者并发症；术后X线片显示椎前间隙无显著差异。我们得出结论，在门诊手术中心（ASC）使用填充DBM的PEEK椎间融合器进行ACDF可以安全进行且效果满意。
