Venkatraman Vishal, Albanese Jessica, Zaidi Saif E, Than Khoi D, Erickson Melissa M, Crutcher Clifford L, Goodwin C Rory, Groff Michael W, Abd-El-Barr Muhammad M
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
J Spine Surg. 2024 Sep 23;10(3):416-427. doi: 10.21037/jss-24-32. Epub 2024 Sep 14.
The use of plate-cage systems in anterior cervical discectomy and fusion (ACDF) has been shown to produce fusion and good clinical outcomes though it has been associated with complications such as dysphagia at higher rates than stand-alone implant devices. This study aimed to assess the incidence of dysphagia and radiographic outcomes in adult patients who have undergone ACDF with interbody spacer with integrated anchor fixation (ISa).
Patients who underwent index ACDF with a commercially available ISa by a fellowship-trained spine surgeon between January 2018 and December 2021 were retrospectively included. Patients with less than 90-days follow-up or those who underwent ACDF for trauma, infection, or tumor were excluded. Demographic data, perioperative data, radiographic data and perioperative complications were collected.
Forty-five patients were included for study. Eight patients (17.8%) experienced dysphagia immediately following surgery, which resolved by 6 months post-op, barring 1 patient. Preoperative global and segmental lordosis were 10.4°±9.3° and 6.9°±7.3° respectively. At three months postoperatively, global and segmental lordosis were 8.9°±7.9° (P=0.50) and 7.0°±5.9° (P=0.56) respectively. Fusion rate at six months was 78.3% (18/23) and 100% (18/18) at 1 year.
ACDF with ISa is a viable alternative to traditional plate-cage systems. ISa shows lower rates of immediate, 3-month and 6-month dysphagia than traditional plate-cage systems described in the literature. More controlled studies on larger populations will help formulate a concrete conclusion on the advantages of ISa spacers.
尽管前路颈椎间盘切除融合术(ACDF)中使用钢板笼系统已被证明可实现融合并取得良好的临床效果,但与单独的植入装置相比,其并发症发生率较高,如吞咽困难。本研究旨在评估接受带集成锚定固定的椎间融合器(ISa)行ACDF的成年患者吞咽困难的发生率和影像学结果。
回顾性纳入2018年1月至2021年12月间由脊柱外科专科培训医生使用市售ISa进行初次ACDF的患者。排除随访时间少于90天的患者或因创伤、感染或肿瘤接受ACDF的患者。收集人口统计学数据、围手术期数据、影像学数据和围手术期并发症。
45例患者纳入研究。8例患者(17.8%)术后立即出现吞咽困难,除1例患者外,其余患者在术后6个月时症状缓解。术前整体和节段性前凸分别为10.4°±9.3°和6.9°±7.3°。术后3个月时,整体和节段性前凸分别为8.9°±7.9°(P = 0.50)和7.0°±5.9°(P = 0.56)。6个月时融合率为78.3%(18/23),1年时为100%(18/18)。
使用ISa行ACDF是传统钢板笼系统的可行替代方案。与文献中描述的传统钢板笼系统相比,ISa在术后即刻、3个月和6个月时吞咽困难的发生率较低。对更多人群进行更严格的研究将有助于就ISa融合器的优势得出具体结论。