Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA.
Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave., Room 779 M, San Francisco, CA 94143-0112, USA.
J Clin Neurosci. 2020 Nov;81:328-333. doi: 10.1016/j.jocn.2020.10.024. Epub 2020 Oct 22.
Pseudarthrosis is a well-recognized complication following multi-level ACDF. We aim to characterize the fusion order and level-specific rates of arthrodesis across four time points following 3-level ACDF. Patients who underwent 3-level ACDF by three UCSF spine surgeons from August 2012 to December 2019 were identified. Fusion status at each level was determined by measuring the interspinous motion on flexion and extension radiographs and assessing for evidence of bridging bone. Measurements were performed post-operatively at 6 weeks, 6 months, 12 months, and 18-24 months. A total of 77 patients with 3-level ACDF were identified and included in this study. Specific ACDF levels include C3-C6 (17 patients), C4-C7 (57 patients), and C5-T1 (3 patients). At 6 months, the cranial, middle, and caudal level fusion rates were 17.0%, 34.0%, and 3.8%, respectively. By 24 months, fusion rates were 61.1%, 88.9%, and 27.8% at the cranial, middle, and caudal level, respectively. PEEK cages were associated with lower odds of multi-level arthrodesis. Arthrodesis occurred the quickest at the middle level with an 88.9% fusion rate by 24 months after surgery. The caudal level had the slowest rate of arthrodesis with only a 27.8% fusion rate at 24 months, likely due to increased biomechanical stress at the most caudal level. Allograft was associated with higher odds of multi-level arthrodesis compared to PEEK cages.
假关节是多节段 ACDF 后公认的并发症。我们旨在描述四组时间点在 3 节段 ACDF 后融合的顺序和特定节段的融合率。
从 2012 年 8 月至 2019 年 12 月，我们确定了三位 UCSF 脊柱外科医生进行的 3 节段 ACDF 的患者。通过测量屈伸位 X 线片的棘突间运动并评估桥接骨的证据来确定每个节段的融合状态。术后 6 周、6 个月、12 个月和 18-24 个月进行测量。
本研究共纳入 77 例 3 节段 ACDF 患者。具体 ACDF 节段包括 C3-C6（17 例）、C4-C7（57 例）和 C5-T1（3 例）。术后 6 个月，颅侧、中间和尾侧节段的融合率分别为 17.0%、34.0%和 3.8%。术后 24 个月时，颅侧、中间和尾侧节段的融合率分别为 61.1%、88.9%和 27.8%。PEEK 笼与多节段融合的可能性降低相关。融合最快的是中间节段，术后 24 个月融合率为 88.9%。尾侧节段融合最慢，术后 24 个月时融合率仅为 27.8%，可能是由于最尾侧节段的生物力学应力增加。与 PEEK 笼相比，同种异体移植物与多节段融合的可能性增加相关。
