Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Division of Pediatric Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York.
Oper Neurosurg (Hagerstown). 2018 Nov 1;15(5):530-537. doi: 10.1093/ons/opy013.
Fusion rates following rigid internal instrumentation for occipitocervical and atlantoaxial instability approach 100% in many reports. Based on this success and the morbidity that can be associated with obtaining autograft for fusion, surgeons increasingly select alternative graft materials.
To examine fusion failure using various graft materials in a retrospective observational study.
Insurance claims databases (Truven Health MarketScan® [Truven Health Analytics, Ann Arbor, Michigan] and IMS Health Lifelink/PHARMetrics [IMS Health, Danbury, Connecticut]) were used to identify patients with CPT codes 22590 and 22595. Patients were divided by age (≥18 yr = adult) and arthrodesis code, establishing 4 populations. Each population was further separated by graft code: group 1 = 20938 (structural autograft); group 2 = 20931 (structural allograft); group 3 = other graft code (nonstructural); group 4 = no graft code. Fusion failure was assigned when ≥1 predetermined codes presented in the record ≥90 d following the last surgical procedure.
Of 522 patients identified, 419 were adult and 103 were pediatric. Fusion failure occurred in 10.9% (57/522) of the population. There was no statistically significant difference in fusion failure based on graft material. Fusion failure occurred in 18.9% of pediatric occipitocervical fusions, but in 9.2% to 11.1% in the other groups.
Administrative data regarding patients who underwent instrumented occipitocervical or atlantoaxial arthrodesis do not demonstrate differences in fusion rates based on the graft material selected. When compared to many contemporary primary datasets, fusion failure was more frequent; however, several recent studies have shown higher failure rates than previously reported. This may be influenced by broad patient selection and fusion failure criteria that were selected in order to maximize the generalizability of the findings.
许多报道显示，对于枕颈和寰枢椎不稳定，采用刚性内固定器械治疗后的融合率接近 100%。基于这一成功以及获取自体移植物融合可能带来的发病率，外科医生越来越多地选择替代移植物材料。
通过回顾性观察研究，使用各种移植物材料检查融合失败。
使用保险索赔数据库（Truven Health MarketScan®[Truven Health Analytics，密歇根州安阿伯]和 IMS Health Lifelink/PHARMetrics [IMS Health，康涅狄格州丹伯里]）确定 CPT 代码 22590 和 22595 的患者。根据年龄（≥18 岁=成人）和关节融合术代码将患者分组，建立 4 个群体。每个群体进一步根据移植物代码分组：第 1 组=20938（结构性自体移植物）；第 2 组=20931（结构性同种异体移植物）；第 3 组=其他移植物代码（非结构性）；第 4 组=无移植物代码。当记录中≥1 个预定代码在最后一次手术≥90d 后出现时，将融合失败定为发生。
在 522 例患者中，419 例为成人，103 例为儿童。在人群中，有 10.9%（57/522）发生融合失败。根据移植物材料，融合失败无统计学差异。在儿童枕颈融合中，融合失败发生率为 18.9%，但在其他组中为 9.2%至 11.1%。
关于接受器械性枕颈或寰枢椎关节融合术患者的行政数据并未显示出融合率与所选移植物材料之间存在差异。与许多当代原始数据集相比，融合失败更为常见；然而，最近的几项研究显示，失败率高于以前的报告。这可能是由于广泛的患者选择和融合失败标准的影响，这些标准是为了最大限度地提高研究结果的普遍性而选择的。
