El Baz Ehab Adel, Sultan Ahmed Maher, Barakat Ahmed Samir, Koptan Wael, ElMiligui Yasser, Shaker Hesham
Agouza Armed Forces Spine Surgery Center, Farid Shawky Street, Giza, Egypt.
Orthopedics and Traumatology Department, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, Egypt.
SICOT J. 2019 Jan;5:8. doi: 10.1051/sicotj/2019002. Epub 2019 Feb 8.
Integrated cage and screw designs were introduced for anterior cervical discectomy and fusion (ACDF) and allegedly are superior to anterior plating due to their minimal anterior profile.
A descriptive study was designed as a prospective case series of 25 patients (30 operated discs) with cervical disc disease treated with a zero-profile cage, and followed up for an average of 16 months (range 12 -18 months). Functional assessment was done with the Neck Disability Index (NDI) and Visual analog scale (VAS) scores for arm and neck pain. Furthermore, Nurick's classification system for myelopathy based on gait abnormalities was documented. Radiological fusion was confirmed with plain X-rays and when indicated with a CT scan at 12 months postoperatively. Dysphagia was classified according to the Bazaz criteria.
VAS for neck and arm pain, NDI, and Nurick Score immediately improved postoperatively and remained so at 12-month follow-up. Fusion was achieved in 19 patients (95%) at six months and in 20 patients (100%) of the single-level group at one year. At six months 80% (four patients) and at 12 months 100% (five patients) showed complete union in the double-level group. No evidence of cage subsidence was noted radiographically.
The favorable lordosis and fusion rates of the low-profile integrated device are consistent with ACDF using anterior plating. Additionally, improved pain and an acceptable rate of dysphagia support the use of integrated interbody spacers for use in ACDF procedures.
一体化椎间融合器和螺钉设计被引入用于颈椎前路椎间盘切除融合术（ACDF），据称由于其最小的前路外形，优于前路钢板固定。
设计了一项描述性研究，作为对25例（30个手术椎间盘）颈椎间盘疾病患者采用零轮廓椎间融合器治疗的前瞻性病例系列，平均随访16个月（范围12 - 18个月）。使用颈部功能障碍指数（NDI）以及手臂和颈部疼痛的视觉模拟量表（VAS）评分进行功能评估。此外，记录基于步态异常的Nurick脊髓病分类系统。术后12个月通过普通X线片确认放射学融合，必要时进行CT扫描。根据Bazaz标准对吞咽困难进行分类。
颈部和手臂疼痛的VAS、NDI以及Nurick评分术后立即改善，并在12个月随访时保持改善。6个月时19例患者（95%）实现融合，单节段组1年时20例患者（100%）实现融合。双节段组6个月时80%（4例患者）以及12个月时100%（5例患者）显示完全融合。影像学检查未发现椎间融合器下沉的证据。
低轮廓一体化装置良好的前凸和融合率与使用前路钢板固定的ACDF一致。此外，疼痛改善以及可接受的吞咽困难发生率支持在ACDF手术中使用一体化椎间融合器。
