Pereira Bernardo de Andrada, Heller Joshua E, Lehrman Jennifer N, Sawa Anna G U, Kelly Brian P
Spinal Biomechanics Laboratory, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Thomas Jefferson University, Philadelphia, PA, USA.
Neurospine. 2021 Mar;18(1):188-196. doi: 10.14245/ns.2040552.276. Epub 2021 Mar 31.
Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation.
Nondestructive flexibility tests (1.5 Nm) performed on 6 cervical C2-7 cadaveric specimens intact and after discectomy (C3-6) in 3 instrumented conditions: allograft with anterior plate (G+P), PCC with allograft and plate (PCC+G+P), and PCC with allograft alone (PCC+G). Range of motion (ROM) data were analyzed using 1-way repeated-measures analysis of variance.
All instrumented conditions resulted in significantly reduced ROM at the 3 instrumented levels (C3-6) compared to intact spinal segments in flexion, extension, lateral bending, and axial rotation (p < 0.001). No significant difference in ROM was found between G+P and PCC+G+P conditions or between G+P and PCC+G conditions, indicating similar stability between these conditions in all directions of motion.
All instrumented conditions resulted in considerable reduction in ROM. The added reduction in ROM through the addition of PCCs did not reach statistical significance. Circumferential fusion with anterior allograft, without plate and with PCCs, has comparable stability to ACDF with allograft and plate.
颈椎前路椎间盘切除融合术（ACDF）是治疗颈椎疾病的常见手术。对于多节段病变，可选择进行环形手术。多节段前路手术的潜在并发症包括吞咽困难和假关节形成，而后路手术的潜在并发症包括颈椎后凸畸形的发展和术后慢性颈部疼痛。在多节段ACDF中添加颈椎后路椎间融合器（PCC）是进行环形融合的一种微创选择。本研究评估了以PCC作为前路同种异体骨移植补充固定（有或无前路钢板固定）的三节段环形融合的生物力学性能。
对6个完整的颈椎C2-7尸体标本以及在3种植入器械情况下椎间盘切除术后（C3-6）的标本进行无损柔韧性测试（1.5 Nm）：同种异体骨移植加前路钢板（G+P）、PCC加同种异体骨移植和钢板（PCC+G+P）以及仅PCC加同种异体骨移植（PCC+G）。使用单向重复测量方差分析对活动范围（ROM）数据进行分析。
与完整脊柱节段相比，在所有植入器械情况下，在C3-6三个植入器械节段处的ROM在屈伸、侧弯和轴向旋转时均显著降低（p < 0.001）。在G+P与PCC+G+P情况之间或G+P与PCC+G情况之间，ROM未发现显著差异，表明在所有运动方向上这些情况之间具有相似的稳定性。
所有植入器械情况均导致ROM显著降低。通过添加PCC导致的ROM额外降低未达到统计学意义。前路同种异体骨移植、无钢板且有PCC的环形融合与同种异体骨移植加钢板的ACDF具有相当的稳定性。
