The use of coral for cervical interbody arthrodesis (IBA) and vertebral body excision

Summary The value of using biomaterials and especially coral in cervical spinal surgery is linked to a desire to eliminate the disadvantages associated with the taking of bone grafts in arthrodeses. A chemical, microscopic, biomechanical and clinical study of coral from 1970 has shown the value of this material, whose structure resembles that of bone, and which degrades completely to be replaced by newly-formed bone. Our initial results in 20 cases confirmed these findings by studying the progress of the coral: its good clinical tolerance, and its excellent radiologic incorporation without modification of spinal statics. Subsequently 83 cases have ben treated with this biomaterial, of which 45 were followed up. The results are satisfactory from both the clinical viewpoint (technques of transdiscal osteophytectomy) and the biomechanical aspect.     

The use of titanium mesh cages in the cervical spine.

Titanium mesh cages have been used widely for spinal reconstruction since 1986 when they first were introduced. Despite their popularity, relatively few studies have been published on their use in the cervical spine. These cages can be used as structural devices containing autologous local bone or iliac crest bone graft, obviating the need to harvest large structural bone grafts. The main disadvantages of their use are the increased costs and the difficulty of assessing fusion status. The authors review surgical techniques that can be used using titanium mesh cages in cervical spine applications and discuss some of their advantages and disadvantages.     

Uninstrumented ventral surgery for subaxial cervical spine tuberculosis: clinical and radiological outcome

The clinical and radiological outcomes in 14 patients with subaxial cervical spine tuberculosis following uninstrumented anterior decompression surgery and medical treatment were retrospectively reviewed. All the patients underwent an anterior decompression with bone graft followed by immediate mobilization or a period of bed rest for 4 to 6 weeks. The clinical status and whole spine curvature of the cervical spine were assessed preoperatively and at follow up. There was an improvement in the Nurick's grade from a preoperative mean of 2.4 (range 0 - 5) to 1.2 (range 0 - 4) at follow up (p = 0.004). The whole spine curvature showed an improvement in 5 patients, was maintained in 6 patients and showed a kyphotic change in 1 of the 12 patients at follow up. There was evidence of good bony fusion in 12 of the 14 patients for whom data were available at follow up. Anterior decompression with autologous iliac bone graft led to a good clinical and radiological outcome in patients with subaxial cervical spine tuberculosis.     

Implant Materials for Anterior Column Reconstruction of Cervical Spine Tumor

The spine is the most common site of bone metastases. Many cancer patients will ultimately develop spinal metastatic disease with symptomatic epidural spinal cord compression. At present, the main treatment for cervical spine tumors is surgical resection combined with postoperative radiotherapy. Implant materials for cervical spine anterior column reconstruction need to meet amounts of different properties, such as biocompatibility, bioactivity and the ability to maintain long-term mechanical strength. The selection of different materials determines the surgical efficacy and prognosis of patients to a certain extent. This article provides an overview of a variety of implant materials used for anterior column reconstruction after cervical spine tumor resection, introduces and analyzes their properties, advantages, disadvantages, derivatives, and applications in clinical practice, and looks forward to the future development of implant materials.     

The effectiveness of biodegradable instrumentation in the treatment of spinal fractures

IntroductionA variety of biodegradable implants (screws, rods, plates and cages) are available which are composed of many different biodegradable polymers with varying characteristics. The present review of animal and clinical studies examines the efficacy and safety of biodegradable implants in spinal fracture intervention.MethodsA review of the literature through March 2018 was performed using PubMed and Cochrane databases. Success rates were calculated according to sufficient tissue biocompatibility, solid clinical fusion and propensity for osseointegration.Results49 articles (24 animal and 25 human studies) were included. In animal experiments, the overall success rate for spinal fusion was 60.3%, while the mean success rate regarding the cervical spine was 51.8% compared to 68.1% for the lumbar spine (p = 0.002). In studies involving control group(s): the mean bioabsorbable implant success rate for spinal fusion was 42% compared to 57% for conventional implants (p = 0.0016). In the lumbar spine pL-lactide acid (PLLA) had 75.2% success rate compared to poly (L-lactide-co-DL-lactide) (PLDLLA) at 53.4% (p = 0.003). In clinical studies, the overall mean success rate was 89%, while the mean success rate regarding the cervical spine was 92%, as compared to 83.6% for the lumbar spine (p = 0.001). In studies involving control group(s): the mean bioabsorbable implant success rate was 75% compared to a conventional implant mean success rate of 97% (p<0.0001). In the cervical spine PLLA had a 98.7% success rate compared to 90% with PLDLLA (p = 0.015). In the lumbar spine PLDLLA had 84.7% success rate compared to 63.6% for poly-glycolic acid (PGA) (p = 0.085).DiscussionStudies combined biodegradable and conventional implants. Polymers were used in various combinations and surface modification of the implants also varied. Comparison studies were of small sample size. Animal and clinical studies diverged. The current data are not encouraging. The end-point of assessing osseointegration varies in the studies and is indeterminate. In early stages the structure comparison of osseous restoration using biodegradable implants appears inferior to utilization of conventional cages and instrumentation. There is no statistically significant evidence supporting the efficacy of biodegradable implants replacing traditional instrumentation. There is a lack of prospective clinical trials with long-term follow-up regarding utilization of biodegradable implants and the available data does not support their routine use in spinal fracture intervention.     

Biodegradierbarer Cage

Bioabsorbable implants are commonplace in knee and shoulder surgery. Bioabsorbable poly(l-lactide-co-D,L-lactide) (PLDLLA) cage devices have potential benefits over autologous tricortical iliac crest bone graft and metallic cages for cervical spine interbody fusion. The purpose of this study was to compare interbody fusion of an autologous tricortical iliac crest bone graft with that of a bioabsorbable cage using a sheep cervical spine interbody fusion model. This study was designed to determine differences in (1) the ability to preserve postoperative distraction, (2) biomechanical stability, and (3) histological characteristics of intervertebral bone matrix formation. Sixteen full-grown Merino sheep underwent C3/4 discectomy and fusion. After 12 weeks, there was no significant difference between the results with the bioabsorbable PLDLLA cages and tricortical bone grafts. The cage also did not show advanced interbody fusion but did, however, show large osteolysis, which allows skepticism regarding the value of this bioabsorbable implant.     

三维平板透视引导上颈椎椎弓根螺钉置入准确性及疗效分析

目的 评价在三维平板透视系统引导下应用上颈椎椎弓根螺钉内固定加植骨融合技术治疗上颈椎骨折的安全性和临床疗效。方法 回顾性分析自2012-06-2013-10我科收治的11例上颈椎骨折脱位病例,均在术中三维平板透视系统引导下采用上颈椎椎弓根螺钉短节段内固定加植骨融合技术进行手术治疗。结果 术后所有患者的颈椎稳定性均得到即刻恢复,44枚螺钉均在位良好,未发生脊髓及椎动脉损伤等任何与置钉相关的并发症,无螺钉断裂、松动。结论 在三维平板透视系统引导下经上颈椎椎弓根螺钉内固定加植骨融合技术治疗上颈椎骨折脱位,螺钉置入准确性高,有效防止置钉并发症,力学稳定性好,植骨融合率高,是上颈椎骨折后路固定术中理想的手术方式之一。     

前路钢板结合钛网植骨在不稳定型下颈椎骨折治疗中的应用

目的观察钛网结合钛钢板内固定治疗不稳定型下颈椎骨折的临床效果。方法对36例不稳定型下颈椎骨折患者应用前路减压、钛网植骨加前路钢板固定,并对其疗效进行评价。结果所有患者随访4~28个月,平均随访17个月,按Frankel评分标准进行术前术后神经功能评定;围手术期无明显并发症,植骨均在术后12周达到临床愈合,颈椎生理曲度保持良好,无椎间盘高度的丢失,钛网无下沉、移位,钢板及螺钉无松动,无神经、血管并发症。术后3.5个月开始出现融合迹象,术后1年骨融合良好。结论不稳定型下颈椎骨折应用前路颈椎钢板固定技术结合钛网植骨治疗,颈椎生理曲度得到恢复,术后颈椎即时稳定性好,并能维持有效的椎间高度,植骨易于融合。通过自体椎体开槽减压取骨或加异体骨植骨避免了髂骨取骨所带来的损伤及手术时间的延长,且住院时间短,有利于患者的早期下床活动和功能恢复。手术病例及方法的选择应根据患者是否有致压因素及颈椎稳定性等情况综合考虑。     

颈前路环钻法减压珊瑚羟基磷灰石植入术

目的　单纯颈椎间盘切除术扰乱颈椎解剖关系 ,自体骨移植常引起供区并发症。本研究采用颈前路环钻法减压、珊瑚羟基磷灰石植入融合术以避免这些并发症。方法　 2 3例颈椎间盘病变患者采用这一治疗 ,年龄 34～ 6 9岁 ,其中单节段融合 2 1例 ,双节段融合 2例。结果　对结果进行临床及颈椎X线检查评定。平均随访 16 8个月 ,临床症状均得到改善 ,取得了坚强的骨愈合并能维持颈椎解剖关系 ,无局部及全身异常反应。结论　颈前路环钻法减压珊瑚羟基磷灰石植入具有应用前景。     

The role of stabilization in the treatment of cervical spine injuries

This presentation started with the assumption that our patient needs a cervical spine operation. Attention has been focused on the questions of which operation is needed and why. Most operations substitute one abnormal situation for another. The second abnormal situation must be beneficial to the patient. It was suggested that we think about the concept of immediate postoperative stability and the methods of achieving it when needed. When decompressions are indicated, we should determine as precisely as possible where the pressure is and what surgical procedure is the best to relieve it. We have suggested that allographs may be as good or in some ways better than autographs. The validity of the statement that bone grafts under tension will be absorbed has been questioned. We have suggested that the maturation of a bone graft can be staged and the patient managed accordingly. The discussion included an analysis of the advantages and disadvantages of some of the surgical constructions that are employed into the occipital-atalantoaxial complex. The importance of preserving motion in this joint as much as is compatible with a solution of the clinical problem was indicated. We suggested the use of the halo applied preoperatively and maintained through surgery in order to have safe, thorough control for the highly unstable situations in the upper cervical spine. In the lower cervical spine the selection of procedures that do not add to already existing instability was emphasized. Opinion was submitted about the relative immediate postoperative stability of the various anterior and posterior procedures in the lower cervical spine. We submitted some ideas about the principles of the use of methylmethacrylate in cervical spine surgery. Specific details of the surgical procedures were discussed when needed and illustrative case reports were included, when they were thought to be helpful.     

Treatment of fractures of the cervical spine with external halo fixation

15 serious injuries of the cervical spine were treated by Halo-fixation devices. Practical procedure as well as advantages in clinical application are dealt with. This method seems to be a good alternative to surgical stabilisation.     

前路钢板固定结合钛网自体骨加异体骨移植治疗颈椎骨折

目的观察钛网容纳自体骨加异体松质骨结合钛钢板内固定治疗颈椎骨折的临床效果。方法采用钛网容纳自体骨加异体松质骨,结合钢板内固定治疗颈椎骨折42例。结果随访4～28个月,平均随访17个月,按JOA评分标准进行术前术后神经功能评定;根据手术前后颈椎X线片判断颈椎生理曲度的恢复,钛网有无下沉、移位及骨融合情况。围手术期无明显并发症,脊髓功能有不同程度改善,颈椎生理曲度部分或全部恢复,钛网无下沉、移位,钢板及螺钉无松动,术后3.5个月开始出现融合迹象,术后1年骨融合良好。结论颈椎骨折采用前路颈椎钢板固定技术结合钛网自体骨加异体松质骨移植治疗,颈椎生理曲度得到恢复,术后颈椎即时稳定性好,通过自体椎体开槽减压取骨加异体骨植骨,避免了髂骨取骨所带来的损伤及手术时间的延长,骨融合率高,患者康复快。     

Box Cages Packed With Local Decompression Bone Were Efficient in Anterior Cervical Discectomy and Fusion: Five- to 10-Year Follow-up

STUDY DESIGN.: A retrospective study. OBJECTIVE.: To assess the radiographical bony union and clinical outcomes of 207 patients who underwent an anterior cervical discectomy and fusion (ACDF) with only local decompression bone for the treatment of cervical disc degeneration. SUMMARY OF BACKGROUND DATA.: Many sources of bone graft have been used for ACDF. Autologous iliac bone is most likely suitable for biologic bone fusion ability, but there may be many problems such as high donor site morbidity. Allograft and artificial bones are less effective for bone fusion. Use of local decompression bone could be a good solution. METHODS.: A total of 207 patients (range, 35-80 yr) underwent ACDF, using carbon fiber-reinforced polyetheretherketone cage lled with local decompression bone with anterior cervical plating to treat symptomatic cervical disorders. Computed tomographic scan of the cervical spine was used to assess fusion rates, and Odom's criteria were used to evaluate the clinical outcome. RESULTS.: Almost all patients had symptomatic improvement, and 97% of patients (201 of 207) exhibited excellent/good clinical outcomes. All interbody disc spacers with local decompression bone achieved successful fusion, confirmed by radiographs and computed tomographic scans, and no cage subsidence occurred at all levels. CONCLUSION.: As applied in anterior cervical fusion, the local decompression bone embedded into carbon fiber-reinforced polyetheretherketone cages is enough and can achieve successful fusion, poignant clinical outcomes while achieving no donor site morbidity.     

三种颈前路椎间融合方法的早期临床评价

目的 评价金属笼状椎间融合器(BAK)、聚醚醚酮椎间融合器(PEEK)、自体髂骨3种颈前路融合材料的临床价值。方法 对63例单节段脊髓型颈椎病患者行前路减压术，融合材料分别选用BAK、PEEK、自体髂骨，进行临床疗效及影像学评价。结果 临床症状改善率3组差异无显著性；在骨性融合时间、椎间隙高度、颈椎弧度丧失、相邻节段后凸畸形等方面，PEEK组最优、BAK组次之、自体髂骨组较差，且自体髂骨组有供骨区并发症。结论 在3种材料中，PEEK具有良好的生物力学优势和生物相容性，能维持椎间隙高度和恢复颈椎曲度，且价廉物美；     

颈椎前路减压植骨钛板内固定治疗颈脊髓损伤

目的评价颈椎前路减压植骨内固定治疗颈椎骨折合并颈脊髓损伤的临床疗效。方法对215例颈椎骨折合并颈脊髓损伤的患者施行颈椎前路减压、自体髂骨植骨和颈椎带锁钛板内固定术。术后定期复查X线片,判定脊髓功能恢复情况。结果随访184例患者,平均随访时间3．5年。术后3个月植骨块获得骨性愈合,颈椎椎间高度和生理曲度维持满意,无内置物并发症,172例患者神经功能提高1～2级,仅12例A级患者神经功能无恢复。结论颈椎骨折合并颈脊髓损伤应尽早行前路减压、植骨、钛板内固定术,有利于脊髓功能恢复,能使损伤节段获得即刻、坚强的稳定,方便护理和功能锻炼。     

颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折

目的评价颈椎前路钛网植骨及带锁钢板固定治疗下颈椎骨折的临床应用价值。方法 2005年5月～2012年12月共收治下颈椎压缩性及爆裂性骨折患者32例,其中颈脊髓损伤患者28例,采用前路减压复位椎体次全切除、钛网植骨及带锁钢板固定方法一期手术治疗。按照Frankel评分系统对神经功能恢复情况进行评价,以X线片测量的Cobb角、"D"值改变评价复位效果、观察融合节段曲度及颈椎生理曲度重建和维持情况。结果不完全脊髓损伤患者Frankel评分恢复平均1级以上。Cobb角、"D"值测量统计表明术前与术后差异有统计学意义(P<0.05),术后即刻与术后随访差异无统计学意义(P>0.05)。结论颈前路钛网植骨及带锁钢板固定治疗下颈椎骨折临床疗效满意,能重建和维持颈椎生理曲度。     

手术治疗严重上颈椎骨折脱位的疗效分析

目的探讨手术治疗严重上颈椎骨折脱位的临床疗效和应用价值。方法采用前后路手术以及颈椎前路钢板和后路钉棒枕颈融合联合复位技术治疗32例严重上颈椎骨折脱位患者。前后路联合手术均在颅骨牵引下经鼻腔气管插管全身麻醉下进行,患者先采用俯卧位,后路植入侧块螺钉、减压、复位,恢复颈椎的序列,植骨融合后拆除颅骨牵引改置仰卧位行前路减压、植骨及自锁钛板固定。术后定期复查X线片观察损伤节段的稳定性和融合率,以Frankel分级判定脊髓神经功能的恢复情况。结果 Frankel分级除6例A级者及3例D级者外,其余患者均有1~2级提高,其中9例达到E级。32例中有3例于术后1个月内死亡,29例获得6~32个月随访。脱位均完全复位,无植骨不融合。损伤节段稳定,颈椎椎间高度及生理曲度都得到良好重建及维持,未出现内固定断裂、松动及脱出,无血管、神经、食道损伤等并发症。结论颈椎前后路联合手术治疗严重上颈椎骨折脱位,能完全恢复颈椎序列,损伤节段术后获得即刻稳定,方便术后护理和功能锻炼,有利于脊髓功能恢复。     

Surgical treatment of old C2 spinal fracture with C2/C3 subluxation using an anterior retropharyngeal approach--case report]

A patient with an inverterate transpedicular fracture of atlas and C2/C3 subluxation, with stenosis of spinal canal by bone fragment, was operated using anterior retropharyngeal approach. Stabilization with interbody cage was performed. During follow up examination both clinical and radiological result was good. This surgical approach seems to be a comfortable approach to the upper cervical spine.     

数字化重建与快速成型技术在复杂上颈椎疾患诊治中的应用

目的:利用数字化三维重建和快速成型技术制作头颈部三维实体模型,并探讨其在复杂上颈椎疾患诊治中的应用效果。方法:采集32例复杂上颈椎疾患患者头颈部CT断层扫描数据,进行数字化三维重建、快速成型制备1∶1三维实体模型,并将其应用于诊治、手术规划和术中参照。结果:32例患者均在三维实体模型指导下完成,手术过程顺利。32例患者术中所见与术前数字化三维重建模型和三维实体模型的病灶结构变化一致,三者间进钉点距中线距离、钉道外倾角及钉道长度与术中实际测量的数据差异无显著性(P>0.05)。术后ASIA评分与术前比较差异有显著性(P<0.01)。术后复查X线、CT和MRI示:脊髓受压解除,病灶清除满意,内固定物在位良好,未出现神经、血管损伤等并发症。结论:数字化重建与快速成型技术能够准确和直观地反映上颈椎病变情况,可指导制定手术计划和手术操作。