Noordhoek Iris, Koning Marvyn T, Jacobs Wilco C H, Vleggeert-Lankamp Carmen L A
Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, the Netherlands.
Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands.
Acta Neurochir (Wien). 2018 Apr;160(4):873-880. doi: 10.1007/s00701-018-3490-3. Epub 2018 Feb 21.
The placement of intervertebral cages in anterior cervical discectomy (ACDF) supposedly maintains foraminal height. The most commonly reported cage-related complication is subsidence, although it is unknown whether a correlation between subsidence and clinical outcome exists.
To assess the incidence and relevance of subsidence.
Literature searches were performed in PubMed, MEDLINE, Embase, Web of Science, COCHRANE, and CENTRAL. The inclusion criteria were as follows: ≥ 20 patients, ADCF with cage, subsidence assessed, and primary data. Risk of bias was assessed using adjusted Cochrane checklists.
Seventy-one studies, comprising 4784 patients, were included. Subsidence was generally defined as ≥ 3-mm loss of height comparing postoperative intervertebral heights with heights at last follow-up. Mean incidence of subsidence was 21% (range 0-83%). Of all patients, 46% of patients received polyether-ether-ketone (PEEK) cages, 31% received titanium cages, 18% received cage-screw-combinations, and 5% received polymethyl-methacrylate (PMMA) cages. Patients treated with cage-screw-combinations had significantly less subsidence than patients treated with PEEK, titanium, or PMMA cages (15.1% vs. 23.5% vs. 24.9% vs. 30.2%; p < 0.001). Thirteen studies assessed clinical outcome in relation to subsidence; the majority did not find a significant correlation. Only four studies correlated subsidence to cage size and/or height; no correlation was established.
Subsidence in ACDF with cages occurs in 21% of patients. The risk for subsidence seems lower using PEEK or titanium cages or adding screws. Whether subsidence affects clinical outcome is not satisfactorily evaluated in the available literature. Future studies on this correlation are warranted in order to establish the additional value of the interposition of a cage in ACDF.
颈椎前路椎间盘切除融合术（ACDF）中椎间融合器的置入理应可维持椎间孔高度。尽管下沉与临床结局之间是否存在关联尚不清楚，但最常报道的与融合器相关的并发症是下沉。
评估下沉的发生率及相关性。
在PubMed、MEDLINE、Embase、科学网、Cochrane图书馆和CENTRAL数据库中进行文献检索。纳入标准如下：≥20例患者、采用融合器的ACDF、评估下沉情况以及原始数据。使用经调整的Cochrane清单评估偏倚风险。
纳入71项研究，共4784例患者。下沉通常定义为将术后椎间高度与最后随访时的高度相比，高度损失≥3毫米。下沉的平均发生率为21%（范围为0 - 83%）。在所有患者中，46%的患者使用聚醚醚酮（PEEK）融合器，31%使用钛融合器，18%使用融合器 - 螺钉组合，5%使用聚甲基丙烯酸甲酯（PMMA）融合器。使用融合器 - 螺钉组合治疗的患者下沉明显少于使用PEEK、钛或PMMA融合器治疗的患者（15.1%对23.5%对24.9%对30.2%；p < 0.001）。13项研究评估了与下沉相关的临床结局；大多数未发现显著相关性。只有4项研究将下沉与融合器尺寸和/或高度相关联；未确立相关性。
ACDF中使用融合器时，21%的患者会出现下沉。使用PEEK或钛融合器或添加螺钉时，下沉风险似乎较低。现有文献中对下沉是否影响临床结局的评估并不令人满意。有必要针对这种相关性开展进一步研究，以确定ACDF中置入融合器的附加价值。
