Spine and Orthopaedic Institute, St Vincent Charity Medical Center, Adjunct, Biomedical Engineering, Cleveland State University, Cleveland, OH.
Center for Spine Health at ClinTech, Fort Collins, CO.
Spine (Phila Pa 1976). 2021 Jan 1;46(1):41-47. doi: 10.1097/BRS.0000000000003702.
Report of surgical technique and long-term outcome; review of prospectively gathered data and follow-up survey of patient cohort.
The aim of this study was to review surgical technique for a trephine graft harvest technique and assess perioperative complications/pain, long-term outcome, and patient satisfaction after anterior iliac crest bone graft (ICBG) harvest for anterior cervical fusion.
Rates of complications and residual pain after ICBG harvest have reduced its utility as a source of autograft for spinal fusion. Less invasive options reduce morbidity, and trephine harvest is a simple technique, with low morbidity and perioperative and long-term pain. It has not been presented in the peer-reviewed spine literature, and the long-term experience has not been previously reported.
Sixty-eight patients undergoing anterior cervical discectomy and fusion (ACDF), using allograft spacers, underwent ICBG harvest using a 3.5 mm trephine by a minimally invasive approach. Perioperative complications, pain incidence and Visual Analog Scale (VAS) were analyzed. Thirty consecutive patients were subsequently surveyed for long-term follow-up regarding pain, function, and satisfaction.
No perioperative (0-6 weeks) graft-site complications (infection, hematoma, fracture, wound dehiscence) occurred. There were no reoperations, and no treatment required for graft-site complaints. No patient reported clinically significant perioperative pain (>3/10). At long-term follow-up (mean 45 months) no patients reported pain >3/10 at their graft-site, and the mean VAS was 0.20/10. No patient was impaired by graft-site symptoms, and all were satisfied with their graft harvest.
Trephine graft harvest minimizes soft tissue dissection, periosteal elevation, and cortical disruption. Outcome using this technique eliminated perioperative complications in this study group, and reduced pain in both perioperative and long-term assessments. Compared to historical outcomes, trephine harvest provides sufficient graft with comparable or improved results relative to other minimally invasive approaches, and significantly improved relative to traditional open techniques.
手术技术和长期结果报告；回顾前瞻性收集的数据和对患者队列的随访调查。
本研究旨在回顾采用环锯取骨技术进行前路髂嵴骨移植（ICBG）的手术技术，并评估前路颈椎融合术前路髂嵴骨移植的围手术期并发症/疼痛、长期结果和患者满意度。
ICBG 采集后并发症和残留疼痛的发生率降低了其作为脊柱融合自体移植物的用途。微创选择可降低发病率，环锯采集是一种简单的技术，具有低发病率和围手术期及长期疼痛。它尚未在同行评议的脊柱文献中提出，并且以前没有报告过其长期经验。
68 例接受前路颈椎间盘切除术和融合术（ACDF）、使用同种异体间隔物的患者采用微创入路使用 3.5mm 环锯进行 ICBG 采集。分析围手术期并发症、疼痛发生率和视觉模拟评分（VAS）。随后对 30 例连续患者进行长期随访，了解疼痛、功能和满意度。
无围手术期（0-6 周）植骨部位并发症（感染、血肿、骨折、伤口裂开）。无再手术，植骨部位无并发症需要治疗。无患者报告有临床意义的围手术期疼痛（>3/10）。在长期随访（平均 45 个月）中，没有患者报告其植骨部位疼痛>3/10，平均 VAS 为 0.20/10。没有患者因植骨部位症状而受损，所有患者对其植骨采集均满意。
环锯取骨术最大限度地减少了软组织解剖、骨膜抬起和皮质破坏。本研究组采用该技术的结果消除了围手术期并发症，并减少了围手术期和长期评估中的疼痛。与历史结果相比，环锯采集提供了足够的移植物，与其他微创方法相比结果相当或改善，与传统的开放技术相比显著改善。
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