Swank M L, Lowery G L, Bhat A L, McDonough R F
Research Institute International, Gainesville, FL 32605, USA.
Eur Spine J. 1997;6(2):138-43. doi: 10.1007/BF01358747.
This retrospective study evaluated a single surgeon's series of patients treated by multilevel cervical disc excision (two or three levels), allograft tricortical iliac crest arthrodesis, and anterior instrumentation. The objective of this retrospective study was to compare fusion success and clinical outcome between multilevel Smith-Robinson interbody grafting and tricortical iliac strut graft reconstruction, both supplemented with anterior instrumentation in the cervical spine. The incidence of nonunion for cervical discectomy and fusion varies widely depending on the number of disc levels involved, type of bone graft used, and whether the anterior grafting is supplemented with instrumentation. An alternative to multilevel interbody fusion is corpectomy and strut grafting, in which the incidence of nonunion has been reported to be 27% with autograft and 41% with allograft. Sixty-four consecutive patients who underwent allograft tricortical iliac crest reconstruction and anterior cervical plating were studied. The average follow-up was 39 months. There were 38 patients in the discectomy and interbody grafting group and 26 patients in the corpectomy and strut graft reconstruction group. Pseudoarthrosis occurred in 42% of the anterior cervical interbody fusion patients and 31% of the corpectomy patients. Nonunion in two-level interbody fusions occurred in 36% of the patients as compared to 10% for patients with one-level corpectomies; while 54% of patients with three-level interbody fusions and 44% of patients with two-level corpectomies were noted to have pseudoarthrosis. Higher percentages of nonunion were noted in multilevel interbody grafting than in corpectomy with strut grafting and when more vertebral levels were involved. These radiographic and clinical findings underscore the shortcomings of multilevel anterior cervical allograft reconstruction with plating. Corpectomy may be the preferred method when multiple disc levels are fused. In addition, anterior corpectomy affords decompression of significant osteophytes in a safer and quicker manner. In retrospective studies, there is a need for long-term follow-up before accurate statements can be made about the study population.
这项回顾性研究评估了由同一位外科医生治疗的一系列接受多节段颈椎间盘切除术（两个或三个节段）、同种异体三面皮质髂嵴骨融合术和前路内固定术的患者。这项回顾性研究的目的是比较多节段Smith-Robinson椎间融合术和三面皮质髂骨支撑移植重建术之间的融合成功率和临床结果，两者均辅以颈椎前路内固定。颈椎间盘切除融合术的不愈合发生率差异很大，这取决于所涉及的椎间盘节段数量、所使用的骨移植类型以及前路移植是否辅以内固定。多节段椎间融合的一种替代方法是椎体次全切除术和支撑移植术，据报道，自体骨移植的不愈合发生率为27%，同种异体骨移植为41%。对64例连续接受同种异体三面皮质髂嵴重建术和颈椎前路钢板固定术的患者进行了研究。平均随访时间为39个月。椎间盘切除术和椎间融合术组有38例患者，椎体次全切除术和支撑移植重建术组有26例患者。颈椎前路椎间融合术患者中42%发生假关节形成，椎体次全切除术患者中31%发生假关节形成。双节段椎间融合术患者中36%发生不愈合，而单节段椎体次全切除术患者中这一比例为10%；三节段椎间融合术患者中有54%、双节段椎体次全切除术患者中有44%被发现有假关节形成。多节段椎间融合术中不愈合的百分比高于椎体次全切除术支撑移植术，且涉及的椎体节段越多。这些影像学和临床结果强调了颈椎前路同种异体骨重建钢板固定术的缺点。当融合多个椎间盘节段时，椎体次全切除术可能是首选方法。此外，前路椎体次全切除术能以更安全、更快的方式对明显的骨赘进行减压。在回顾性研究中，需要进行长期随访才能对研究人群做出准确的陈述。
