Verla Terence, Xu David S, Davis Matthew J, Reece Edward M, Kelly Michelle, Nunez Mervin, Winocour Sebastian J, Ropper Alexander E
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Semin Plast Surg. 2021 Feb;35(1):10-13. doi: 10.1055/s-0041-1722853. Epub 2021 May 10.
Failed fusion in the cervical spine is a multifactorial problem stemming from a combination of patient and surgical factors. Patient-related risk factors such as steroid use, poor bone quality, and smoking can be optimized preoperatively. Age, prior radiation, prior surgery, and underlying genetics are nonmodifiable patient-centered risk factors. Surgical risks for failed fusion include the number of segments fused, anterior versus posterior approach for fusion, the type of bone graft, and the instrumentation utilized. Many symptomatic cases of failed fusion (pseudarthrosis) result in pain, neurological deficits, or loosened hardware necessitating a revision surgery consisting of extending the prior construct and utilizing additional allografts or autografts to augment the fusion. Given the relatively mobile nature of the cervical spine, pseudoarthrosis (either known or anticipated) must be recognized by the spine surgeon, and steps should be considered to optimize the likelihood of future fusion. This consists of both performing a rigid fixation and using appropriate bone graft to enhance the environment for arthrodesis. Vascularized bone grafts are a useful tool to augment fusion and provide added structural stability in cases at high risk of pseudoarthrosis.
颈椎融合失败是一个多因素问题，源于患者因素和手术因素的综合作用。术前可对与患者相关的危险因素进行优化，如使用类固醇、骨质不佳和吸烟等。年龄、既往放疗史、既往手术史以及潜在的遗传学因素是以患者为中心的不可改变的危险因素。融合失败的手术风险包括融合节段数量、前路与后路融合方式、骨移植类型以及所使用的内固定器械。许多融合失败（假关节形成）的症状性病例会导致疼痛、神经功能缺损或内固定松动，需要进行翻修手术，包括延长先前的固定结构并使用额外的同种异体骨或自体骨来增强融合效果。鉴于颈椎相对灵活的特性，脊柱外科医生必须识别假关节形成（无论是已知的还是预期的），并应考虑采取措施来提高未来融合的可能性。这包括进行坚固固定并使用合适的骨移植来改善关节融合的环境。带血管蒂骨移植是增强融合并在假关节形成高风险病例中提供额外结构稳定性的有用工具。
