Yang Sen, Yu Yang, Liu Xun, Zhang Zehua, Hou TianYong, Xu Jianzhong, Wu Wenjie, Luo Fei
Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing.
Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
Medicine (Baltimore). 2019 Nov;98(45):e17935. doi: 10.1097/MD.0000000000017935.
Recently, many kinds of cages for cervical fusion have been developed to avoid the related complications caused by tricortical iliac crest graft. The existing literature has reported the excellent clinical efficacy and superior fusion rate. However, various types of cages have their own disadvantages. Which bone graft material is the best choice for cage with the fewest complications? At present, there is still no conclusion.
By reviewing patients with 1 to 2-level cervical degenerative disease in our hospital with a novel cage made of allograft or polyetheretherketone (PEEK), we evaluated the efficacy and reliability of the new cage in anterior cervical discectomy and fusion (ACDF). From 2015 to 2016, a prospective review of 58 and 49 consecutive cases with spondylotic radiculopathy or myelopathy undergoing ACDF using allograft (group A) and PEEK (group B) cage were performed. The follow-up ranged from 12 to 40 months. Intraoperative index, clinical outcome and complications were recorded. Radiographs evaluated segmental and overall cervical lordosis, the height of the intervertebral space, interbody height ratio (IHR), cage positioning, and fusion state.
A total of 134 cages were implanted. Compared to preoperatively, the visual analog scale (VAS) and neck disability index (NDI) were reduced postoperatively without any change during the subsequent follow-up in both groups. There was no migration or extrusion of the cages at the latest follow-up. There were 2 and 4 patients suffering dysphagia respectively. In both groups, the intervertebral height, IHR, segmental and overall cervical lordosis were significantly greater than pre-operation (P < .05) and were maintained at the last follow-up, but were not statistically significant (P > .05). The allograft group achieved a fusion rate of 100% (58/58) according to CT scans at 3 months post-operation, while PEEK group was 91.8% (45/49), which reached 95.9% (47/49) at 6 months and 100% at 12 months. In addition, the fusion state was maintained in all patients at the last follow-up.
Our data showed that the new allograft cage is superior to the PEEK cage in providing a high fusion rate and fewer complications after 1-level and 2-level ACDF procedures. It may represent an excellent alternative to other cages.
近年来，为避免三皮质髂嵴植骨相关并发症，已研发出多种颈椎融合器。现有文献报道了其良好的临床疗效和较高的融合率。然而，各类融合器均有其自身缺点。哪种骨移植材料是并发症最少的融合器的最佳选择？目前尚无定论。
通过回顾我院采用同种异体移植物或聚醚醚酮（PEEK）制成的新型融合器治疗1至2节段颈椎退变疾病的患者，我们评估了新型融合器在前路颈椎间盘切除融合术（ACDF）中的疗效和可靠性。2015年至2016年，对连续58例和49例因神经根型颈椎病或脊髓型颈椎病接受ACDF手术的患者进行前瞻性研究，分别使用同种异体移植物（A组）和PEEK（B组）融合器。随访时间为12至40个月。记录术中指标、临床结果及并发症。通过X线片评估节段性和整体颈椎前凸、椎间隙高度、椎间高度比（IHR）、融合器位置及融合状态。
共植入134个融合器。与术前相比，两组术后视觉模拟评分（VAS）和颈部功能障碍指数（NDI）均降低，且在随后随访期间无变化。在最近一次随访时，融合器均无移位或脱出。分别有2例和4例患者出现吞咽困难。两组的椎间高度、IHR、节段性和整体颈椎前凸均显著高于术前（P <.05），并在最后一次随访时得以维持，但差异无统计学意义（P >.05）。根据术后3个月的CT扫描，同种异体移植物组的融合率为100%（58/58），而PEEK组为91.8%（45/49），6个月时达到95.9%（47/49），12个月时达到100%。此外，在最后一次随访时，所有患者的融合状态均得以维持。
我们的数据表明，在1节段和2节段ACDF手术后，新型同种异体移植物融合器在提供高融合率和较少并发症方面优于PEEK融合器。它可能是其他融合器的优秀替代品。
