Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Dogok 1(il)-dong, Gangnam-gu, Seoul, 06273, Korea.
Acta Neurochir (Wien). 2022 Dec;164(12):3173-3180. doi: 10.1007/s00701-022-05377-6. Epub 2022 Oct 17.
This is a retrospective study.
Implant nonfusion is an important prognostic factor for patients after anterior cervical discectomy and fusion (ACDF). This study aimed to investigate endplate-specific pseudarthrosis after ACDF, to determine if the rate of fusion is inferior in the lower endplate, and to identify any differences in clinical and radiological results. Research comparing each endplate on which the endplate affects nonfusion is limited.
We analyzed 71 patients with 142 total spinal levels who underwent double-level ACDF (C4-5-6 and C5-6-7) with an allograft and plate at our hospital between January 2012 and December 2018. Fusion grades were assessed using computed tomography and the Bridwell fusion grade system at 1 year postoperatively. Radiological parameters were obtained from lateral cervical radiographs collected preoperatively and at 1 month and 1 year after surgery.
There was no difference in fusion between the C4-5-6 and C5-6-7 ACDF procedures, but the fusion rate and Bridwell fusion grade at the caudal surgery level were lower than those at the cranial surgery level (93 vs. 79%, p < 0.001). The lower endplate of the caudal fusion level showed the most common pseudarthrosis (18 of 71 [25%]). There was no difference in radiological parameters and clinical outcomes between the fusion and pseudarthrosis groups.
In double-level ACDF procedures, the nonfusion rate was higher at the caudal fusion levels, especially at the lower endplates of the caudal fusion levels.
这是一项回顾性研究。
颈椎前路椎间盘切除融合术（ACDF）后，植骨非融合是患者的一个重要预后因素。本研究旨在探讨 ACDF 后终板特异性假关节形成的情况，确定下位终板的融合率是否较低，并确定临床和影像学结果是否存在差异。目前比较每个终板对非融合影响的研究相对较少。
我们分析了 2012 年 1 月至 2018 年 12 月期间在我院接受双节段 ACDF（C4-5-6 和 C5-6-7）治疗的 71 例患者，共 142 个节段，采用同种异体骨和钢板。术后 1 年通过 CT 评估融合等级，并采用 Bridwell 融合分级系统进行评估。在术前、术后 1 个月和 1 年，从侧位颈椎 X 线片获取影像学参数。
C4-5-6 和 C5-6-7 节段 ACDF 手术之间的融合率没有差异，但下位手术水平的融合率和 Bridwell 融合分级均低于上位手术水平（93%比 79%，p<0.001）。下位融合水平的下位终板最常见假关节形成（71 例中 18 例[25%]）。融合组和假关节组在影像学参数和临床结果方面没有差异。
在双节段 ACDF 手术中，下位融合水平的非融合率较高，尤其是下位融合水平的下位终板。
