Effect of posterior subsidence on cervical alignment after anterior cervical corpectomy and reconstruction using titanium mesh cages in degenerative cervical disease

Subsidence after anterior cervical reconstruction using a titanium mesh cage (TMC) has been a matter of debate. The authors investigated and analyzed subsidence and its effect on clinical and radiologic parameters after cervical reconstruction using a TMC for degenerative cervical disease. Thirty consecutive patients with degenerative cervical spine disorders underwent anterior cervical corpectomy followed by reconstruction with TMC. Twenty-four patients underwent a single-level corpectomy, and six patients underwent a two-level corpectomy. Clinical outcomes were assessed using a Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI). Fusion status, anterior and posterior subsidence of the TMC, segmental angle (SA) and cervical sagittal angle (CSA) were assessed by lateral and flexion-extension radiographs of the neck. The mean follow-up period was 27.6 months (range, 24 to 49 months). The VAS, NDI and JOA scores were all significantly improved at the last follow-up. No instances of radiolucency or motion-related pseudoarthrosis were detected on radiographic analysis, yielding a fusion rate of 100%. Subsidence occurred in 28 of 30 patients (93.3%). The average anterior subsidence of the cage was 1.4 ± 0.9 mm, and the average posterior subsidence was 2.9 ± 1.2 mm. The SA and CSA at the final follow-up were significantly increased toward a lordotic angle. Anterior cervical reconstruction using TMC and plating in patients with cervical degenerative disease provides good clinical and radiologic outcomes. Cage subsidence occurred frequently, especially at the posterior part of the cage. Despite the prominent posterior subsidence of the TMC, SA and CSA were improved on final follow-up radiographs, suggesting that posterior subsidence may contribute to cervical lordosis.     

Corpectomy with titanium cage reconstruction in the cervical spine

Multi-level anterior cervical discectomy and fusion (ACDF) has been utilized by many surgeons to address multi-level cervical disease with the use of autograft or allograft. High failure rates have been reported in three-level decompressions when autograft is used, which increases with the use of allograft. This has led many surgeons to advocate anterior cervical corpectomy with strut grafting where only two surfaces are needed for fusion compared to the multiple surfaces required for multi-level ACDF. We retrospectively evaluated the efficacy of titanium cage use with autologous bone graft (resected vertebral bodies) and anterior cervical plating in 38 consecutive patients (aged 18-73 years) undergoing cervical decompression and corpectomy. Medical records were examined along with an outcome interview conducted in-person or by phone. Postoperative immobilization was achieved with a rigid cervical collar. Fusion was assessed by antero-posterior (AP), lateral, and flexion-extension radiographs and cervical spine CT scans. Fusion was assessed by AP, lateral, and flexion-extension radiographs and cervical spine CT scans. Clinical results included an exit interview. Solid bony fusion with graft incorporation was found in 37 of 38 patients (97.5%) at six months and 100% in one year. Compared to preoperative levels, 84% of patients rated their overall quality of life to have improved by 50% or greater and would have the same surgery again given the same conditions. There were few complications. Thus, titanium cage reconstruction with the use of autologous bone from a corpectomy and the use of an anterior cervical plate is an effective means of reconstruction after decompressive cervical corpectomy, and we conclude this is a viable alternative to multi-level ACDF or to procedures involving long strut grafts obtained from the patient or bone bank.     

纳米羟基磷灰石增强聚酰胺66颈椎仿生骨块材料生物力学分析

背景：颈椎前路次全椎体减压后形成的椎体骨骼缺损,需要相关的脊柱支撑物。临床上有自体髂骨和钛合金椎间融合器应用,但均有相关的并发症和不适现象。 目的：自行研发的生物型颈椎仿生骨块在尸体标本上进行相关的生物力学分析,验证其生物学强度和稳定性。 设计、时间及地点：对比观察实验,于2008-09/10在上海大学生物力学实验室完成。 材料：南京航空航天大学材料科学与技术学院制备的纳米羟基磷灰石增强聚酰胺66颈椎仿生骨块,尺寸为1.2 cm×1.4 cm×2 cm的中空柱状物,中空为直径0.5 cm（2 cm为植入物长度可以根据实际骨槽的长度进行缩短）,其内填塞在前路手术中磨碎的骨渣。 方法：16具新鲜男性冰冻尸体C1~T1部位颈椎标本及自体髂骨条,先期测量未侵入操作颈椎的生物应力作为正常组,测试后行颈椎前路次全椎体切除,一组植入自体髂骨条,钢板螺钉固定;另一组植入仿生椎体填塞骨渣,同样钢板螺钉固定。将待测标本安装在WD-5电子万能试验机上进行生物力学测量。 主要观察指标：颈椎的轴向刚度、颈椎强度、颈椎旋转能力。 结果：自体髂骨组的轴向刚度、颈椎强度、扭转力均明显低于正常组和颈椎仿生骨块植入组（P < 0.05）。颈椎仿生骨块植入组的生物力学特性与正常组比较,差异无显著性意义（P > 0.05）。 结论：纳米羟基磷灰石增强聚酰胺66颈椎仿生骨块强度大、刚度高、颈椎稳定性好。     

Clinical experience using polyetheretherketone (PEEK) intervertebral structural cage for anterior cervical corpectomy and fusion

Anterior cervical corpectomy and fusion (ACCF) is commonly performed for various pathologies involving the cervical spine. Although polyetheretherketone (PEEK) cages have been widely used following anterior cervical discectomy and fusion (ACDF), clinical literature demonstrating its efficacy following ACCF is sparse. A retrospective review of patients enrolled in a prospective database who underwent single/multi-level ACCF was performed. Fifty-nine patients were identified who underwent corpectomy reconstruction with PEEK cages for symptomatic degenerative, neoplastic, infectious, or traumatic pathologies of the cervical spine. Thirty-five patients having at least 6 months follow-up (FU) were included in the final analysis. The mean age of patients was 51 years (range, 18–81 years) with FU ranging from 6 to 33 months (mean, 6.6 months). None of the patients had dysphagia at last FU. There was no implant failure with fusion occurring in all patients. While 57% of patients (20/35) remained stable with no progression of myelopathy, 43% (15/35) improved one (11 patients) or two (four patients) Nurick grades after surgery. The use of PEEK cages packed with autograft or allograft is safe and effective following anterior cervical corpectomy, demonstrating high fusion rates and good clinical results. This synthetic material obviates the morbidity associated with autograft harvest and possible infectious risks of allograft. The wide array of cage dimensions facilitates ease of use in patients of all sizes and appears safe for use in the typical pathologic conditions encountered in the cervical spine.     

Use of titanium expandable vertebral cages in cervical corpectomy

We aimed to investigate the usefulness of titanium expandable cages for vertebral body reconstruction after anterior cervical corpectomy. The records of 29 patients treated with expandable titanium cages for a variety of indications were analysed retrospectively. There was evidence of fusion in all patients. There was no radiographic evidence of more than 4mm subsidence throughout the series. There were no hardware failures. Our results show that expandable titanium cages are safe and useful in anterior cervical corpectomies for providing adequate anterior column support and solid constructs without significant hardware complications or the risk and morbidity associated with the use of strut allograft or autograft.     

Subsidence and its effects on the anterior plate stabilization in the course of cervical interbody spondylodesis. Part II. Clinical evaluation. Study design

STUDY DESIGN: Subsidence is a common phenomenon in the process of interbody fusion. The paper presents a retrospective clinical and radiological evaluation of subsidence in a group of 23 patients after cervical corpectomy with mesh cage and plate stabilization. Subsidence magnitude and its impact on the stabilizing system and on the clinical and radiological outcome were estimated. MATERIAL AND METHOD: The mesh cage and cervical plate stabilization was preformed after one- (20 cases) or two-level (3 cases) corpectomy. The patients' mean age was 35 years (age range 18-72); 9 patients were aged over 50. Indications to corpectomy were: neurological impairment due to burst body fractures in 14 cases, multilevel spondylosis in 5, and OPLL in 2 patients. One patient had a kidney cancer metastasis. The mean follow-up period was 17 months (range 12-28 mo.). The patients' clinical status was evaluated using the ASIA scale in the post-traumatic group, and the Odom criteria in spondylotic cases. In all the cases pain severity was estimated by the VAS scale. Magnitude of subsidence was measured on consecutive lateral x-rays during the follow-up. Bone fusion was confirmed after 3 months in lateral flexion-extension x-rays. Changes in the local and general cervical lordosis were evaluated during the follow-up. RESULTS: A 72-year-old patient died after 6 weeks due to causes unrelated to the surgery. In all the remaining patients bone fusion was attained. There were no cases of the clinical status deterioration during the follow-up. Subsidence of over 1 mm was found in 19 patients (86.4%). The mean value of subsidence was 2.2 mm, but in a group of older patients (aged over 50) it amounted to 2.8 mm. In 4 cases (18.1%) with hardware complications, i.e. a screw breakage or slipping, the mean subsidence magnitude was 4.3 mm. Local and general cervical lordosis were maintained during the follow-up period, even in the group with excessive subsidence. The screw breakage site was invariably the round hole of the plate. CONCLUSIONS: The subsidence phenomenon is seen in a majority of fused patients. Nevertheless, clinical and radiological results of the surgery are good. An excessive subsidence may result from hardware complications. In newly designed plates subsidence should be taken into account.     

脊柱内镜下半椎板切除术与ACDF治疗颈椎管狭窄症的对比分析

目的 对比分析脊柱内镜下半椎板切除术和颈椎前路椎间盘切除融合术（ACDF）治疗颈椎管狭窄症（CSS）的疗效。方法 回顾性分析2015年1月至2019年12月手术治疗的50例单节段或双节段CSS的临床资料。26例行ACDF（ACDF组），24例行脊柱内镜下半椎板切除术（内镜组）。50例术后随访6~62个月，其中内镜组平均随访（24.4±16.4）个月，ACDF组平均随访（25.7±18.0）个月。结果 内镜组手术时间、术中出血量与住院时间较ACDF组均明显减少（P<0.05）。两组末次随访日本骨科协会（JOA）评分、颈椎功能障碍指数量表评分及视觉模拟量表评分较术前均明显改善（P<0.05），但两组之间均无明显差异（P>0.05）。两组JOA评分改善率、临床疗效均无统计学差异（P>0.05）。结论 脊柱内镜下半椎板切除术和ACDF治疗CSS的疗效相当，但脊柱内镜下半椎板切除术具有创伤小、风险低、恢复快等优点。     

Bryan人工颈椎间盘置换治疗颈椎病的中期临床随访

背景：Bryan人工颈椎间盘置换的短期疗效优良已被大多数学者公认,但有关其中长期临床效果及并发症的资料较少。 目的：总结Bryan人工颈椎间盘置换治疗颈椎病的中期临床效果。 方法：选择2004-11/2007-12在四川大学华西医院骨科接受Bryan人工颈椎间盘置换的颈椎间盘突出症患者34例,其中单节段置换30例,双节段置换4例。于置换前、置换后7 d、3,6,12,24,36,48个月行SF-36生活质量量表评分、JOA评分、颈部及上肢疼痛目测类比评分;以颈椎正侧位及功能位X射线片测量手术节段、邻近节段及C2~7屈伸活动度的变化,手术节段和邻近节段椎间高度变化及手术节段的轴向平移情况。 结果与结论：所有患者置换后神经症状均明显好转,各随访点SF-36生活质量量表躯体评分和心理评分、JOA评分、颈部和上肢疼痛目测类比评分较置换前明显改善(P < 0.05),3个月之后各随访时点两两比较差异无显著性意义(P > 0.05)。置入的Bryan假体历次随访均保留了>2°的活动度,未发现手术节段异位骨化与自发性融合,随访48个月时手术节段及C2~7屈伸活动度较置换前略有增加,但差异无显著性意义(P > 0.05);上下邻近节段屈伸活动度维持了置换前水平;手术节段的椎间高度由置换前的(6.04±1.02) mm增加到(8.44±0.43) mm(P < 0.05);上下邻近节段椎间高度及手术节段的轴向平移均维持了置换前水平。说明Bryan人工颈椎间盘治疗颈椎间盘退变性疾病的中期临床效果良好,较好的保留了手术节段、邻近节段及整个颈椎的运动学特性,且近中期并发症很少。     

Bryan人工颈椎间盘置换与椎间融合治疗颈椎病的中期疗效比较

背景：国内外有许多相关报道颈人工椎间盘置换治疗颈椎病取得了非常好的近期临床疗效，但因其刚刚开展不久，缺乏长期随访结果。 目的：观察Bryan人工颈椎间盘置换治疗颈椎病的临床和影像学结果及邻近节段活动度的情况，并与椎间融合治疗方法比较。 设计、时间及地点：回顾性病例分析，于2004-10/2006-04在河北医科大学第三医院脊柱外科完成。 对象和方法：22例患者行Bryan假体置换（置换组），同期行常规颈前路椎间盘切除减压植骨融合内固定患者30例（融合组）。在术后1周、3个月、6个月、12个月、24个月进行随访，在每一次随访中拍摄颈椎前屈后伸位、左右侧屈位X射线片，观察置换组假体稳定性及融合组融合节段骨性融合情况。 主要观察指标：①材料与宿主的生物相容性。②临床疗效评估。 结果：全部病例随访最短24个月，平均30.6个月。①融合组患者术后6个月植骨全部骨性融合；内固定无松动、脱落、断裂的发生。置换组患者置换后无假体移位、脱落等并发症发生。②两组患者随访时神经功能均得到明显恢复，两组JOA评分差异无显著性意义（P > 0.05）。③置换组1例患者随访2年发生椎间自发融合，置换节段活动丢失；其余21例患者置换节段活动度与置换前差异无显著性意义（P > 0.05）。④融合组术后邻近节段的活动度较术前明显增大（P < 0.05）；而置换组置换前后邻近节段活动范围差异无显著性意义（P > 0.05）。 结论：与前路融合方法比较，中期随访结果显示Bryan人工颈椎间盘置换治疗颈椎病在取得满意临床疗效的同时能保留置换节段的活动，且避免了置换后上下邻近节段活动度的增加。     

Oral Extrusion of Screw after Anterior Cervical Interbody Fusion

We present a case of delayed oral extrusion of a screw after anterior cervical interbody fusion in a 68-year-old man with osteoporosis. Fifteen months earlier, he had undergone C5 corpectomy and anterior cervical interbody fusion at C4-6 for multiple spinal stenoses. The patient was nearly asymptomatic, except for a foreign body sensation in his throat. We conclude that the use of a mesh graft or other instrument in elderly patients and those with osteoporosis or problematic bone quality should be considered carefully and that if surgery were to be performed, periodic postoperative follow-up evaluations are mandatory.     

Multisegmental cervical ossification of the posterior longitudinal ligament: anterior vs posterior approach

AIMS: To determine the surgical approach in patients with multisegmental (four or more segments) OPLL of the cervical spine. METHODS AND MATERIALS: Data of 27 patients who had undergone either an anterior (corpectomy with excision of OPLL and interbody fusion = 14 patients) or posterior approach (laminectomy = 12, laminoplasty = 1 patient) for the multisegmental cervical OPLL was analyzed retrospectively. The patients in each group were statistically similar in respect to preoperative factors such as age, duration of symptoms, preoperative modified Japanese orthopedic association score, OPLL thickness, effective canal diameter, and antero-posterior cord compression ratio. The clinical outcome was assessed by the Harsh grading system and recovery rate was assessed by Hirabayashi method. RESULTS: There was no statistical difference in the outcome, and recovery rate. Nine patients developed complications after anterior approach in contrast to one after posterior approach. CONCLUSIONS: In patients with multisegmental cervical OPLL, there was no significant difference in the short-term recovery rate and outcome between two groups. The immediate postoperative complications were less in patients who had undergone posterior approach. From our analysis, it appears that the posterior approach is probably the preferred method of treatment in a multisegmental OPLL in absence of preoperative kyphosis.     

Tantalum trabecular metal implants in anterior cervical corpectomy and fusion: 2-year prospective analysis

Anterior cervical decompression for two or more cervical spondylotic levels can be performed using either multiple anterior cervical discectomies and fusion or anterior cervical corpectomy and fusion (ACCF). A variety of options for ACCF implants exist but to our knowledge, there is no clinical data for the use of tantalum trabecular metal implants (TTMI) for ACCF. A retrospective review was performed of prospectively collected data for ten patients undergoing ACCF with TTMI between 2011 and 2012. Radiological outcome was assessed by measuring the change in cervical (C) lordosis (fusion Cobb and C2–C7 Cobb), graft subsidence (anterior/posterior, determined by the subsidence of anterior/posterior body height of fused segments; cranial/caudal, determined by the cranial/caudal plate-to-disc distances) and rate of fusion using lateral cervical X-rays of patients at 0, 6, 12 and 24 months post-operatively. The Neck Disability Index (NDI) assessed clinical outcome pre-operatively and at 6, 12 and 24 months post-operatively. Cervical lordosis (Cobb angle of fused segment) was 5.2° (± 4.2°) at 0 months and 6.0° (± 5.7°) at 24 months post-operatively. Graft subsidence was observed to occur at 6 months post-operatively and continued throughout follow-up. Anterior, posterior and caudal subsidence occurred more in the first 12 months post-operatively than in the following 12 months (p < 0.05). Average pre-operative NDI was 45%. Average NDIs were 18%, 13% and 10% at 6, 12 and 24 months post-operatively, respectively. ACCF patients treated with TTMI demonstrated stable cervical lordosis over 2 years of follow-up and 100% fusion rates after 2 years. Measures of subsidence appeared to decrease with time. Patients experienced improved clinical outcomes over the 2-year period.     

无骨折脱位型颈脊髓损伤3种金属置入物疗效观察

背景：近年来,随着解剖学、影像学、外科技术的发展及国内外学者研究的深入,无骨折脱位型颈脊髓损伤的相关治疗取得了长足进步。 目的：观察前路重建脊柱稳定、后路减压+侧块固定、前路重建脊柱稳定+后路减压治疗无骨折脱位型颈脊髓损伤的效果。 方法：回顾性分析2003-10/2005-12解放军广州军区广州总医院脊柱外科收治的无骨折脱位型颈脊髓损伤患者27例,男22例,女5例,均伤后7 d内入院,并行手术治疗。根据患者的损伤情况采用3种方式,前路减压重建脊柱稳定,后路单开门+侧块固定,前路重建脊柱稳定+后路减压。疗效评价标准采用Frankel分级及JOA评分计算改善率。 结果与结论：全部患者均获得随访,随访时间6~33个月,平均18个月。影像学复查提示减压充分,内固定固定良好,未见松动滑脱、断裂等现象,融合节段1年后均获得良好骨性融合。27例患者出院时神经系统症状均有不同程度改善。除1例Frankel A级患者无明显恢复外,其余均恢复1~4级。置入后JOA评分较置入前有明显改善,其中前路减压重建脊柱稳定组改善率为50%,后路单开门+侧块固定组改善率为53%,前路重建脊柱稳定+后路减压组改善率为51%。所有病例置入中未出现血管、神经损伤等并发症,随访中亦无并发症发生。提示根据无骨折脱位型颈脊髓损伤的不同特点,采取合理方式,可获得较好疗效。     

纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体在骨质疏松性胸腰椎爆裂骨折前路手术中的应用

背景：胸腰椎前路手术中,植入物塌陷是影响胸腰段骨折患者疗效的重要因素之一,尤其是骨质疏松患者发生植入物塌陷、钉道松动、植骨不愈合、脊柱后凸畸形的缺陷更加明显。纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体具有良好的生物相容性及生物安全性,是一种比较理想的椎体植骨替代材料。 目的：观察纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体治疗骨质疏松性胸腰椎爆裂骨折的疗效。 设计、时间及地点：回顾性病例分析,病例来自于2004-01/2008-01泸州医学院附属医院脊柱外科。 对象：20例中重级骨质疏松性胸腰椎骨折患者,男6例,女14例;年龄51~82岁,平均69岁。新鲜骨折17例,陈旧性骨折3例。纳米羟基磷灰石/聚酰胺66复合人工椎体为四川国纳科技有限公司生产,该人工椎体直径10~35 mm,长度30~ 100 mm,呈圆柱状,中空直径3~12 mm,管壁厚度2.5~6.5 mm,椎体四周为直径2 mm小孔,人工椎体接触面积为78.5~176.7 mm2。固定物为佛山施太保公司的前路钉板系统,系钛合金材料。 方法：常规气管插管全麻,取右侧卧位,根据骨折累及的节段不同而选用不同部位的切口,行前路减压、纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体支撑,钢板内固定。 主要观察指标：X射线片观察骨折愈合情况、植入体松动情况,并比较术前、术后3个月及末次随访时的Cobb角、伤椎高度及脊髓功能评分。 结果：所有患者均顺利完成手术,术中出血 200~800 mL,手术时间2.0~3.0 h,术后患者肺部感染1例,伤口延迟愈合1例。20例患者均获得随访,随访时间6~42个月(平均18个月)。术后X射线片复查显示相邻椎体三四个月愈合,植入体无明显移位,重建的椎体高度丢失少。内固定位置良好,无断钉断棒及内固定松动移位等现象。术后3个月Cobb角、伤椎高度及脊髓功能评分与术前比较差异有显著性意义(P < 0.05),而术后两次随访差异无显著性意义(P > 0.05)。 结论：纳米羟基磷灰石/聚酰胺66复合生物活性人工椎体应用于骨质疏松性胸腰椎爆裂骨折前路手术可增大植骨融合面积,减少局部压强,防止植入体松动下沉,有效恢复椎体的高度。 关键词：胸腰椎爆裂骨折;骨质疏松;生物材料;人工椎体     

外视镜下行颈椎前路椎间盘切除融合术治疗颈椎病的疗效

目的探讨外视镜下行颈椎前路椎间盘切除融合术(ACDF)治疗颈椎病的有效性和安全性。方法回顾性分析2017年3月至2019年3月复旦大学附属中山医院神经外科收治的15例颈椎病患者的临床资料,所有患者均行外视镜下ACDF。术后行临床随访和影像学随访,以患者的Odom评分和日本骨科协会(JOA)颈椎评分评估手术疗效。结果15例患者(19个节段)的手术用时为(100±6)min(80~160 min),术中出血量为(75±10)ml(40~150 ml)。椎间盘融合比例为19/19。1例患者术后发生一过性声音嘶哑,无一例死亡。所有患者均获随访,随访时间为(11.3±1.7)个月(3~27个月)。术后3个月的Odom评分结果表明,非常满意12例,满意3例。15例患者术后3个月的JOA颈椎评分为(15.8±0.2)分,高于术前的(13.3±0.4)分(t=5.8,P<0.01)。所有患者术后的症状均明显缓解,脊髓功能明显改善。结论外视镜下行ACDF治疗颈椎病的效果良好,且并发症少,值得在临床上推广应用。     

Bryan人工椎间盘置换术治疗脊髓型颈椎病

目的总结应用Bryan人工椎间盘置换术治疗脊髓型颈椎病的疗效。方法回顾性分析应用Bryan人工椎间盘置换术治疗的20例脊髓型颈椎病患者,共25个置换节段,其中单节段15例,双节段5例。应用JOA17分法评价术前和末次随访时的临床神经功能状况,并作统计学检验。观察末次随访时颈椎侧位X线片上假体与椎体的相互位置关系以及假体所在椎间隙的活动度。结果所有病人得到随访,随访时间3～24个月,平均15个月。病人术后症状有明显缓解,JOA评分由术前平均10．4分上升至术后平均15．2分。术后随访未见有假体松动、下沉和周围骨化融合,置换间隙前屈后伸活动范围平均为（4．8±1．7）°。结论Bryan人工椎间盘置换术早期临床效果良好,能达到确切的稳定性和部分的活动度保留。     

3D外视镜辅助前路颈椎间盘切除融合术治疗脊髓型颈椎病的疗效

目的 探讨3D外视镜辅助前路颈椎间盘切除融合术(ACDF)治疗脊髓型颈椎病的效果.方法 回顾性分析2019年1～6月3D外视镜辅助ACDF治疗的15例脊髓型颈椎病的临床资料.术后随访12～16个月,平均(14.40±1.45)个月,采用日本骨科协会(JOA)评分评估神经功能.结果 所有病人均在3D外视镜辅助下顺利完成手...     

Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis

Pseudarthrosis occurs after approximately 2–20% of anterior cervical discectomy and fusion (ACDF) procedures; it is unclear if posterior or anterior revision should be pursued. In this study, we retrospectively evaluate the outcomes in 22 patients with pseudarthrosis following ACDF and revision via posterior cervical fusion (PCF). Baseline demographics, preoperative symptoms, operative data, time to fusion failure, symptoms of pseudarthrosis, and revision method were assessed. Fusion outcome and clinical outcome were determined at last follow-up (LFU). Thirteen females (59%) and 9 (41%) males experienced pseudarthrosis at a median of 11 (range: 3–151) months after ACDF. Median age at index surgery was 51 (range: 33–67) years. All patients with pseudarthrosis presented with progressive neck pain, with median visual analog scale (VAS) score of 8 (range: 0–10), and/or myeloradiculopathy. Patients with pseudarthrosis <12 months compared to >12 months after index surgery were older (p = 0.013), had more frequent preoperative neurological deficits (p = 0.064), and lower baseline VAS scores (p = 0.006). Fusion was successful after PCF in all patients, with median time to fusion of 10 (range: 2–14) months. Eighteen patients fused both anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS neck score at LFU significantly improved from the time of pseudarthrosis (p = 0.012). While uncommon, pseudarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudarthrosis after posterior stabilization. Neck pain significantly improved by LFU in the majority of patients in this study.     

骨修复用纳米羟基磷灰石/聚酰胺66的体内外生物相容性

背景：采用基于纳米羟基磷灰石溶胶新方法制备纳米羟基磷灰石/聚酰胺66复合材料,该材料提高了纳米羟基磷灰石在聚酰胺66基体中的均匀分布和二者的有效键合,进而有利于改善材料的生物性能,有望成为新型骨修复材料。 目的：评价纳米羟基磷灰石/聚酰胺66复合材料体内外生物相容性。 方法：①将原代培养的成骨细胞与纳米羟基磷灰石/聚酰胺66及聚酰胺66材料复合培养,使用倒置相差显微镜和场发射扫描电子显微镜观察材料周围及表面的细胞形态。②将纳米羟基磷灰石/聚酰胺66复合材料植入兔右侧胫骨,将聚酰胺66作为对照组材料植入兔左侧胫骨。在术后2,8周,取材料周围骨组织进行病理组织切片观察。 结果与结论：①纳米羟基磷灰石/聚酰胺66和聚酰胺66未表现出明显的细胞毒性,纳米羟基磷灰石/聚酰胺66材料周围细胞形态好于聚酰胺66,且纳米羟基磷灰石/聚酰胺66表面细胞数量多于聚酰胺66,在复合培养的第3天差异尤其显著(P < 0.01)。②在植入早期,与纳米羟基磷灰石/聚酰胺66相接的骨组织成骨细胞活跃且该组材料周围的骨形成过程较对照组更快。结果说明纳米羟基磷灰石/聚酰胺66复合材料较聚酰胺66有更好的生物相容性。 关键词：纳米羟基磷灰石/聚酰胺66;聚酰胺66;生物相容性;细胞培养;骨修复材料 doi:10.3969/j.issn.1673-8225.2010.08.044     

A multicenter retrospective research of anterior debridement,decompression, bone grafting,and instrumentation for cervical tuberculosis

ABSTRACT

Objective: To observe the clinical effect of anterior debridement, decompression, bone grafting, and instrumentation for cervical spinal tuberculosis in four hospitals.

Materials and Methods: This research retrospectively analyzed 146 patients with cervical spinal tuberculosis who were treated by anterior debridement, decompression, bone grafting, and instrumentation in four institutions between January 2000 and January 2015. There were 68 males and 78 females with an average age of 31.32 ± 11.69 years. All patients received chemotherapy for 18 months after surgery, and fixed by brace for 3 months. Clinical outcome, laboratory indexes and radiological results were analyzed to evaluate the efficacy of anterior approach surgery in the treatment of cervical spinal tuberculosis.

Results: All cases were followed up about 18 to 52 months later (average 24 months). At the last follow-up, all patients obtained bone fusion, pain relief and neurological recovery. There was no recurrence in any of the patients, and no complications related to internal fixation. There were statistically significant differences before and after treatment in terms of Visual analog scale (VAS), Neck disability index (NDI) and Japanese Orthopedic Association (JOA)(P < 0.05). During the last follow-up examination, in 83 patients with neurological deficit, 78 patients improved. The kyphosis was significantly improved postoperatively (P < 0.05). At the last follow-up, the Cobb angle had some degree of correction loss, but the difference was not statistically significant.

Conclusion: Our study suggests that one-stage anterior debridement, decompression, bone grafting, and instrumentation are safe and effective methods in the surgical management of cervical spinal tuberculosis.

Abbreviation: VAS: Visual Analog Scale; JOA: Japanese Orthopaedic Association; NDI: Neck Disability Index; ESR: Erythrocyte Sedimentation Rate; ASIA: American Spinal Injury Association; TB: Tuberculosis