Yu Derron, Panesar Paramjyot Singh, Delman Connor, Van Benjamin W, Wilson Machelle D, Le Hai Van, Roberto Rolando, Javidan Yashar, Klineberg Eric O
Spine Center, University of California, Davis, Sacramento, California, USA.
University of California, Davis School of Medicine, Sacramento, California, USA.
World Neurosurg X. 2022 May 31;16:100126. doi: 10.1016/j.wnsx.2022.100126. eCollection 2022 Oct.
The objective of this retrospective study is to compare the fusion rates in anterior cervical discectomy and fusion surgery using freeze-dried versus fresh-frozen allografts.
The study comprised 79 patients. Fifty-one patients received freeze-dried allograft (106 total spinal levels) and 28 patients received fresh-frozen allograft (50 total spinal levels). Fusion was assessed through trabecular bridging on follow-up anterior-posterior/lateral radiographs. Trabecular bridging was assessed on the superior and inferior borders of each spinal level and given a fusion grade. Complete fusion is defined as >50% bridging between superior and inferior borders of the bone graft; union is complete fusion in <26 weeks; delayed union is complete fusion after 26 weeks; and fibrous union is <50% bridging at ≥1 borders over 52 weeks.
All spinal levels reached complete fusion for both graft types. Of the freeze-dried treated cervical spinal levels, 77.35% (82/106) reached union (adequate trabecular bridging within 6 months) without delay compared with 80% (35/50) for the fresh-frozen bone graft group ( = 0.85). There was no significant difference in time-to-fusion analysis and no significant association between delayed union and any patient factors. In assessing Neck Disability Index (NDI), freeze-dried allografts did show a significantly greater decrease in NDI scores at 6 months ( = 0.03). At the 1 year follow-up, improvements in NDI were consistent in both allografts ( = 0.9647).
From this study, freeze-dried and fresh-frozen allografts showed comparable rates of union, and both allografts can be used interchangeably for anterior cervical discectomy and fusion.
本回顾性研究的目的是比较在颈椎前路椎间盘切除融合手术中使用冻干同种异体骨与新鲜冷冻同种异体骨的融合率。
该研究纳入79例患者。51例患者接受冻干同种异体骨（共106个脊柱节段），28例患者接受新鲜冷冻同种异体骨（共50个脊柱节段）。通过随访时的前后位/侧位X线片上的小梁桥接来评估融合情况。在每个脊柱节段的上下边界评估小梁桥接情况并给出融合分级。完全融合定义为骨移植上下边界之间桥接>50%；愈合是指在<26周内实现完全融合；延迟愈合是指在26周后实现完全融合；纤维性愈合是指在52周以上≥1个边界处桥接<50%。
两种移植类型的所有脊柱节段均实现了完全融合。在接受冻干处理的颈椎节段中，77.35%（82/106）无延迟地实现了愈合（6个月内小梁桥接充分），而新鲜冷冻骨移植组为80%（35/50）（P = 0.85）。融合时间分析无显著差异，延迟愈合与任何患者因素之间也无显著关联。在评估颈部功能障碍指数（NDI）时，冻干同种异体骨在6个月时NDI评分的下降确实显著更大（P = 0.03）。在1年随访时，两种同种异体骨在NDI方面的改善是一致的（P = 0.9647）。
从本研究来看，冻干和新鲜冷冻同种异体骨的愈合率相当，两种同种异体骨均可在颈椎前路椎间盘切除融合术中互换使用。
