Lee E J, Hung Y C, Lee M Y, Yan J J, Lee Y T, Chang J H, Chang G L, Chung K C
Department of Surgery, National Cheng Kung University Medical Center and Medical School, Tainan, Taiwan.
Neurosurgery. 1999 Jan;44(1):139-46; discussion 146-7. doi: 10.1097/00006123-199901000-00085.
This study was conducted to evaluate the kinematic response of late fusion results for cervical spine discectomies with and without bone grafting.
Fifteen Barbados Black Belly sheep underwent sham operations (Group A, n = 5), C2-C3 discectomies only (Group B, n = 5), and C2-C3 discectomies with autologous iliac bone grafting (Group C, n = 5). Ten months after surgery, the animals were killed. Fresh ligamentous spines (C1-C5) were subjected to the relevantly applied loads through a loading frame attached to the C1. Each vertebra (from C2 to C4) was attached with a set of three infrared light-emitting diodes to record the spatial location relating to each load application using a Selspot II system (Selcom Selective Electronics, Inc., Valdese, NC). The load-deformation data of the C2-C3 and C3-C4 motion segments were recorded and analyzed for the three groups.
At the C2-C3 motion segment, the results indicated that Group B displayed larger motion ranges of rotation and lateral bending loads than did the other two groups. Significantly larger motion ranges of rotation loads were found in Group B than in Group C (P<0.05, for both comparisons). In contrast, Group C had the smallest motion ranges of flexion, lateral bending, and rotation loads. At the C3-C4 motion segment, both groups that had undergone discectomies had a significantly larger motion range of flexion load compared with Group A (P<0.05, for both comparisons). A significant increase in the motion range of right axial rotation was found in Group B (P<0.05), but not in Group C, compared with Group A. Group B exhibited larger motion ranges responding to all six tested loads than did Group C.
The results indicate that anterior fusion after C2-C3 cervical discectomies, regardless of the presence or absence of bone grafting, decreases the motion range of flexion load at the C2-C3 motion segment, and contrary data were seen at the C3-C4 motion segment. For axial rotation loads, discectomies without bone grafting resulted in increased motion ranges of both C2-C3 and C3-C4 motion segments whereas discectomies with bone grafting did not. The data may have clinical relevance regarding the role of bone grafting in cases of cervical spine disease.
本研究旨在评估颈椎间盘切除术在有或无植骨情况下晚期融合结果的运动学反应。
15只巴巴多斯黑腹羊接受了假手术（A组，n = 5）、单纯C2 - C3椎间盘切除术（B组，n = 5）以及C2 - C3椎间盘切除并自体髂骨植骨术（C组，n = 5）。术后10个月，处死动物。将新鲜的韧带完整的脊柱（C1 - C5）通过连接在C1上的加载框架施加相关负荷。每个椎体（从C2到C4）附着一组三个红外发光二极管，使用Selspot II系统（Selcom Selective Electronics, Inc., Valdese, NC）记录与每次负荷施加相关的空间位置。记录并分析三组C2 - C3和C3 - C4运动节段的负荷 - 变形数据。
在C2 - C3运动节段，结果表明B组在旋转和侧弯负荷下的运动范围比其他两组更大。B组的旋转负荷运动范围显著大于C组（两次比较P均<0.05）。相比之下，C组在屈曲、侧弯和旋转负荷下的运动范围最小。在C3 - C4运动节段，与A组相比，接受椎间盘切除术的两组在屈曲负荷下的运动范围均显著更大（两次比较P均<0.05）。与A组相比，B组的右轴向旋转运动范围显著增加（P<0.05），而C组未增加。B组对所有六种测试负荷产生的运动范围均大于C组。
结果表明，C2 - C3颈椎间盘切除术后的前路融合，无论有无植骨，都会降低C2 - C3运动节段的屈曲负荷运动范围，而在C3 - C4运动节段观察到相反的数据。对于轴向旋转负荷，无植骨的椎间盘切除术导致C2 - C3和C3 - C4运动节段的运动范围增加，而有植骨的椎间盘切除术则没有。这些数据可能与颈椎疾病病例中植骨的作用具有临床相关性。
