零切迹颈前路椎间融合固定系统在颈前路融合术中的初步应用

目的探讨零切迹颈前路椎间融合固定系统(Zero-p ACIF)在颈椎前路融合术中的应用效果。方法 2009-12-2010-10,对24例(26节段)颈椎疾病患者行前路椎间零切迹椎间融合固定系统内固定,其中颈椎外伤性椎间盘突出、不稳7例,颈椎间盘疾患17例,其中双节段2例。结果24例患者随访12～20个月,平均随访14个月,JOA评分由术前平均8.6分上升到末次随访时15.2分,术后X线片与末次X线片提示椎间高度无丢失,内固定无松动。结论 Zero-p ACIF有较优异的材料和力学性能,能有效维持融合椎间高度,对椎前组织无影响,是一种新的颈前路融合手段。     

零切迹颈前路椎间融合固定系统治疗食管型颈椎病1例

食管型颈椎病是颈椎病的一种少见类型,其发病率约占颈椎病中的2%[1,2]。目前国内外关于其治疗报道较少,近期我院采用新型零切迹颈前路椎间融合固定系统治疗食管型颈椎病患者一例,现报道如下。     

颈前路零切迹椎间融合固定双节段颈椎病

[目的]比较颈前路零切迹椎间融合(Zero-P)固定系统与常规笼架-钢板系统用于前路颈椎间切除融合术治疗双节段颈椎病的临床效果.[方法]回顾性分析2016年5月～2019年3月手术治疗的双节段颈椎病患者120例,其中,62例采用零切迹固定系统,58例采用常规笼架-钢板系统.比较两组患者围手术期、随访和影像资料.[结果]...     

颈前路减压零切迹椎间植骨融合固定系统治疗脊髓型颈椎病疗效观察

目的观察颈前路减压零切迹椎间植骨融合固定系统(Zero-P)治疗脊髓型颈椎病的效果。方法对78例脊髓型颈椎病患者实施颈前路减压联合Zero-P治疗。通过JOA评分和Odom标准评价手术疗效,同时观察并发症和植骨融合等情况。结果78例患者手术均顺利完成。手术时间(81.34±4.18)min,术中出血量(38.34±2.16)m L。均未发生损伤脊髓神经、食管、气管,切口感染、脑脊液漏以及硬膜外血肿等并发症。患者术后均获1~2 a的随访,术后1个月及术后6个月JOA评分均明显高于术前,差异有统计学意义(P0.05)。经颈椎X线检查,均达到植骨融合,未发生邻近节段退变性疾病而导致二次手术;无吞咽困难、内固定松动、断裂、金属过敏等现象。末次随访依据Odom标准评价治疗效果:优良率为96.15%。结论颈前路减压联合Zero-P治疗脊髓型颈椎病,优良率及植骨融合率高、并发症少、神经功能改善明显。     

微创小切口零切迹颈前路椎间融合器治疗单节段脊髓型颈椎病的疗效评价

[目的]探讨新型零切迹颈前路椎间融合器(zero profile anterior cervical interbody fusion cage,ACIFC)单独应用于单节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)微创小切口治疗的手术特点和近期临床疗效.[方法]对收治的43例中老年单节段CSM患者采用颈椎前路横行小切口,椎间盘髓核摘除、减压、ACIFC单独置入植骨融合内固定术,分析手术特点,对比手术前后、末次随访的临床疗效(VAS和JOA评分)及影像学融合节段椎间隙高度、Cobb角变化,判断椎间稳定性及椎间融合率.[结果]手术时间(55±10) min;术中失血(35±10) ml.住院时间(5.2±1.2)d,术后吞咽困难发生率2.3％.术后随访(18.5±4.5)个月(13 ～26个月),43例患者术前VAS评分(6.5±1.5)分,JOA评分9.2±1.7分,末次随访VAS评分(1.2±0.8)分,JOA评分(15.6±1.8)分,JOA评分术后:优23例,良15例,可4例,差0例,优良率90.7％.术后1周和末次随访与术前相比融合节段椎间隙高度和Cobb角明显改善(P＜0.01),术后1周与末次随访比较无明显间隙高度和角度丢失(P＞0.05),随访过程中未发现融合器及内固定螺钉松动、移位,末次随访颈椎过屈、过伸位X线片判断椎间稳定率100％,X线片判断椎间融合率65.1％ (28/43).[结论]ACIFC单独应用于单节段CSM微创小切口治疗的手术创伤小,操作简单,并发症低,住院时间短,达到微创化手术效果,可有效改善和维持颈椎的病变节段生理曲度和椎间隙高度,有良好的力学稳定性能,临床近期疗效满意.中远期疗效需进一步随访评估.     

颈前路减压零切迹椎间植骨融合内固定系统治疗颈椎病的早期疗效分析

目的:分析颈前路减压零切迹椎间植骨融合内固定系统(Zero-P)治疗颈椎病的早期疗效。方法 :2010年6月~10月39例颈椎病患者接受颈前路减压Zero-P植骨内固定手术,患者年龄33~71岁,平均50.3岁。神经根型颈椎病8例,脊髓型31例;单间隙14例,2个间隙18例,3个间隙7例。共置入Zero-P 71枚,C3/4、C4/5、C5/6、C6/7椎间隙置入Zero-P分别为8、19、30、14枚。术前、术后2个月及12个月对神经根型颈椎病患者行VAS评分、脊髓型颈椎病患者行JOA评分,在颈椎中立侧位X线片上测量颈椎Cobb角(C2和C7椎体后缘切线的夹角),观察术后吞咽不适的发生率以及症状持续时间。根据术后伸屈侧位X线片观察手术间隙有无异常活动。结果:手术时间48~130min,平均86min;术中出血量40~310ml,平均110ml。14例患者术后1周内出现吞咽不适,其中13例术后2个月内症状消失,1例(2.6%)症状持续至术后4个月消失。随访12~16个月,平均14.6个月。神经根型颈椎病患者术后2个月、12个月时的VAS评分分别为1.5±0.8分、1.3±0.9分,均低于术前的7.3±1.3分(P<0.05)。脊髓型颈椎病患者术后2个月、12个月时的JOA评分分别为14.6±1.1分、15.0±1.2分,均高于术前的9.7±1.7分(P<0.05)。术后2个月及12个月颈椎Cobb角分别为18.4°±9.6°、17.8°±9.2°,大于术前的9.0°±10.0°(P<0.05)。术后12个月时的VAS评分、JOA评分和颈椎Cobb角与术后2个月比较无显著性差异(P>0.05)。随访期间手术间隙无异常活动,内置物无移位。结论:颈前路减压Zero-P植骨内固定治疗颈椎病的早期疗效满意,稳定性可靠,可重建颈椎曲度,术后慢性吞咽不适发生率低。     

前路复位减压零切迹椎间融合器内固定治疗下颈椎脱位

目的:探讨一期颈椎前路复位、减压、零切迹椎间融合器内固定术治疗下颈椎脱位的效果。方法:2010年10月~2013年6月收治25例不合并椎板骨折内陷的下颈椎脱位患者,脊髓损伤程度按照Frankel分级:A级4例,B级10例,C级6例,D级4例,E级1例;损伤部位:C3/4 2例,C4/5 5例,C5/6 8例,C6/7 10例;单侧关节突脱位绞锁8例,双侧关节突脱位绞锁17例;受伤至入院时间2h~3d,平均7.6h。均急诊全麻下一期行颈椎前路复位、减压、零切迹椎间融合器内固定治疗,复位方法包括全麻下颅骨牵引、椎体间撑开撬拨复位。结果:全麻下颅骨牵引重量10~15kg,时间10~30min,13例复位,12例未复位。12例颅骨牵引未复位患者中,8例单侧关节突绞锁患者于术中通过椎间盘切除减压后偏中心椎体间撑开、单侧撬拨全部复位,4例双侧关节突绞锁患者通过椎间盘切除减压后椎体间撑开、撬拨复位。手术时间为61±12min(40~82min),术中出血量为180±25ml(100~600ml)。术后出现脑脊液漏1例,未发生大血管、喉返神经损伤或气胸等并发症,无1例出现术后吞咽不适感。随访6.8±2.2个月(5~12个月)。术后3~5个月影像学复查示椎间植骨均获骨性愈合;25例颈椎序列好、内固定位置良好、无内固定移位及断裂。末次随访时,A级2例、B级3例、C级1例、D级1例、E级1例脊髓功能无变化,其余患者脊髓功能均有不同程度改善。JOA评分由术前7.2±0.8分改善至末次随访时的13.8±0.6分,改善率为67.3%。结论:一期全麻下颈椎前路复位、减压、零切迹椎间融合器内固定术治疗下颈椎脱位可达到早期复位、减少脊髓受压时间、手术时间短、固定可靠、减少术后吞咽不适感发生率、疗效满意的效果。     

颈前路减压零切迹椎间融合器治疗脊髓型颈椎病的疗效

目的探讨颈前路减压零切迹椎间融合器(Zero-P)治疗脊髓型颈椎病的疗效。方法选取40例接受经颈前路椎间盘切除、脊髓减压术的脊髓型颈椎病患者,随机分为2组,每组20例。对照组采用融合器植入、钉板系统内固定术,观察组应用ZeroP行椎间固定融合术。记录2组手术时间、术中出血量、术后引流量及并发症。比较手术前后颈椎Cobb角、JOA评分及VAS评分。结果观察组手术时间短于对照组,差异有统计学意义;2组术中出血量、术后引流量比较差异无统计学意义(P0.05);术后观察组颈椎Cobb角、JOA评分均高于对照组,VAS评分、并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论颈前路减压Zero-P治疗脊髓型颈椎病,手术时间短、疼痛轻、并发症少、且颈椎功能恢复好。     

新型颈椎前路椎间融合固定系统（Zero—P）治疗颈椎病的疗效分析

背景：颈椎前路减压融合内固定术是治疗颈椎病的有效手段。但接骨板内固定在增加融合率的同时常导致一些并发症。目的：探讨一种新型零切迹颈椎前路椎间融合固定系统（Zero-P）治疗颈椎病的疗效,以降低术后并发症的发生率。方法：2010年6月至2011年6月对51例颈椎病患者行颈椎前路减压融合术。A组33例使用椎间融合器联合钛板固定;B组18例使用Zero-P。比较两组手术时间,术中出血量,JOA评分及改善率,NDI评分,术后融合率,术后并发症发生率。结果：A组随访9～18个月,平均12个月：B组随访6～19个月,平均10个月。两组手术时间,术中出血量,JOA评分及改善率,NDI评分,融合率均无显著差异（P〉O．05）。但B组术后并发症发生率明显低于A组（尸〈0．05）。结论：Zero-P能降低术后并发症的发生率,尤其是吞咽不适的发生,是一种值得进一步临床应用的颈椎前路椎间融合固定系统。     

零切迹颈椎前路椎间融合固定系统治疗颈椎病及无骨折脱位颈脊髓损伤

目的：探讨零切迹颈椎前路椎间融合固定系统（简称 Zero-P 系统）治疗颈椎病及无骨折脱位颈脊髓损伤患者的临床疗效。方法对行颈椎前路手术的14例颈椎病患者（16节段）和5例无骨折脱位颈脊髓损伤患者（5节段）采用 Zero-P 系统进行减压固定。观察手术时间、术中出血量、术后早期并发症;颈椎病患者采用 JOA 评分评价疗效。结果手术时间为55～120（75±16）min;术中出血量为50～450（150±85）ml。术后11例出现吞咽困难,2～5 d 基本恢复,未出现其他早期并发症。患者均获随访,时间3个月～3年6个月,末次随访时14例颈椎病患者 JOA 评分改善率为72．7％,其中优9例,良3例,中2例;5例颈脊髓损伤患者Frankel 分级均为 E 级。影像学资料提示术后椎间融合良好,未出现临近节段椎间盘退变。结论仅需处理椎间盘的颈椎前路手术采用 Zero-P 系统进行减压固定,可以取得早期良好的临床疗效,但应注意患者的选择。     

Anterior Cervical Discectomy (ACD) Versus Anterior Cervical Fusion (ACF), Clinical and Radiological Outcome Study

Summary  This study was conducted on 90 patients with symptomatic cervical disc disease with one or two-level disc pathology.  Clinical and radiological outcome was compared to determine which technique was advantageous for patients with disc disease.  Problems related to donor site as well as those related to fusion bed and grafts have stimulated investigators to avoid fusion.  Patients were allocated at random for either the ACF (n=50) or the ACD (n=40) procedures. The standard Smith-Robinson technique was performed on all patients in this study. Patients were followed-up clinically and radiologically according to the study protocol.  The clinical long-term outcome was comparable in both groups, though those who had ACF were more satisfied. There was significant incidence of kyphosis in the ACD group (P=0.02). Osseous union was slow and less satisfactory with ACD (64%) than with ACF (94%). Pain at the donor site was not a significant problem in the long-term. Hospital stay and operative time was shortened in ACD patients though not significantly. Spondylotic patients were less satisfied with ACD though not significantly.  Conclusions. The issue of whether to fuse or not to fuse has not come to an end yet. The technique is still in need of more refinement of disc excision and graft harvesting and shaping, as well as more adequately controlled studies. Until that, ACD has to be limited to those patients with a soft single disc without spondylosis.     

Comparison of Anterior Cervical Discectomy and Fusion with Cervical Laminectomy and Fusion in the Treatment of 4‐Level Cervical Spondylotic Myelopathy

ObjectiveTo assess and compare the therapeutic effects of Anterior Cervical Discectomy and Fusion (ACDF) and Cervical Laminectomy and Fusion (CLF) in the treatment of 4‐level cervical.MethodsWe performed a retrospective review on 39 patients with 4‐level CSM who underwent ACDF or CLF in the Third Hospital of Hebei Medical University from January 2010 to December 2018. The patients were divided into ACDF group and CLF group according to the treatment. The operative index was evaluated based on intraoperative blood loss and operation time. The functional outcomes including Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS) of axial pain were compared. The Cobb angle, Cobb angle improvement rate, range of motion (ROM) and ROM loss ratio were measured for radiographic evaluation.ResultsNo major complications or deaths occurred. The average age at baseline was 55 years. There was no significant difference between the ACDF and CLF group in follow‐up time (26.29 months, 25.39 months, P > 0.05). The intraoperative blood loss was higher in the CLF group than in the ACDF group (692.67 ± 38.68 vs 392.14 ± 128.06, P < 0.05). The operation time was longer in the CLF group than in the ACDF group (206.60 ± 49.37 vs 172.64 ± 31.96, P < 0.05). Significant improvements in the VAS and JOA scores were observed in both groups (P < 0.05). No significant difference in VAS was found between the ACDF and CLF groups (P < 0.05). There was a significantly larger improvement rate of JOA score in the ACDF group than in the CLF group (60.9% ± 9.57% vs 31.5% ± 15.70%, P < 0.05). There were two (9.6%) cases with complications In the ACDF group, including one (4.8%) case of dysphagia and one (4.8%) case of pharyngodynia. In the CLF group, two patients (11.1%) developed C₅ palsy. No significant difference in the incidence of complications, ROM loss ratio and Cobb angle improvement rate was found between group ACDF and group CLF (all P < 0.05).ConclusionBoth ACDF and CLF were effective in the treatment of multi‐level cervical spondylosis and ACDF is more suitable for patients with 4‐level CSM.     

颈前路经皮椎间盘摘除术在早期颈椎病中的应用

为探讨经皮椎间盘摘除术在颈椎病治疗中的适应证及疗效,在局麻下对30例颈椎病患者30个椎间盘行颈前路经皮穿刺切除术,其中C_(4-5)16例,C_(5～6)14例。术后随访6～24个月。结果:13例术前症状体征完全缓解,8例症状体征显著改善,优良率70％。表明颈前路经皮椎间盘摘除术在颈椎病治疗中是一种可行、有效的措施,严格选择适应证是提高成功率的关键。     

Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review

Controversy remains over whether anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF) is superior for the treatment of cervical radiculopathy. We therefore performed a systematic review including three prospective randomized controlled trails (RCT) and seven retrospective comparative studies (RCoS) by searching PubMed and EMBASE. These studies were assessed on risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions, and the quality of evidence and level of recommendation were evaluated according to the GRADE approach. Clinical outcomes, complications, reoperation rates, radiological parameters, and cost/cost‐utility were evaluated. The mean complication rate was 7% in the ACDF group and 4% in the PCF group, and the mean reoperation rate was 4% in the ACDF group and 6% in the PCF group within 2 years of the initial surgery. There was a strong level of recommendation that no difference existed in clinical outcome, complication rate and reoperation rate between the ACDF and the PCF group. There was conflicting evidence that the ACDF group had better clinical outcomes than the PCF group (one study with weak level of recommendation). PCF could preserve the range of motion (ROM) of the operated segment but did not increase the ROM of the adjacent segment (weak level of recommendation). Meanwhile, the average cost or cost‐utility of the PCF group was significantly lower than that of the ACDF group (weak level of recommendation). In conclusion, the PCF was just as safe and effective as the ACDF in the treatment of cervical radiculopathy. Meanwhile, PCF might have lower medical cost than ACDF and decrease the incidence of adjacent segment disease. Based on the available evidence, PCF appears to be another good surgical approach in the treatment of cervical radiculopathy.     

Efficacy of Postoperative Radiograph for Evaluating the Prevertebral Soft Tissue Swelling after Anterior Cervical Discectomy and Fusion

Background

After surgery for degenerative spinal disease by the anterior approach, the degree of soft tissue swelling can be assessed simply using plain radiographs. However, there are little studies according to the surgical methods or extent of surgery, and no study had addressed the clinical meaning of swelling determined by plain radiography. The purpose of this study was to evaluate the clinical significance of prevertebral soft tissue swelling (PSTS) after anterior cervical fusion with plate fixation for the treatment of degenerative cervical spinal disorders.

Methods

One hundred and thirty-five patients that underwent anterior cervical fusion with plate augmentation for degenerative cervical spondylosis were included in this study. PSTS differences were analyzed with respect to numbers of fusion segments and location of fusion. Cases were divided into two groups based on the amount of PSTS, and incidences of dyspnea, dysphagia, dysphonia were evaluated.

Results

PSTS increments were significantly greater in patients that had undergone multi-level or high-level fusion. Complications of dyspnea, dysphagia and dysphonia were found more frequently in patients with marked PSTS group.

Conclusions

Increments of PSTS after anterior cervical fusion for degenerative spinal disorders are greater and incidences of complications are higher in patients that undergo multi-level or high-level fusion. Thus, measurement of PSTS using consecutive cervical lateral radiographs after anterior cervical surgery is clinically meaningful procedure.     

一体化颈椎钢板融合器在颈椎疾患治疗中的应用

目的评价一体化颈椎钢板融合器(the plate cage benezech implant,PCB)的优越性。方法自2003年5月至2006年8月,针对20例颈椎疾患患者采用PCB内固定治疗,术后行3~32个月的随访。结果按照JOA评分,术前评分为8~13分,平均9.8分,术后评分为12~16分,平均14.8分,术后改善率为84.6%。平均手术时间104 min,对比同期56例颈前路单节段椎间盘切除钛网植骨钢板内固定平均手术时间131 min,手术时间有显著性差异(P<0.05)。未出现医源性颈髓损伤、颈椎失稳、固定物松动现象,术后6个月CR平片示植骨融合良好。结论PCB是集融合器的优越性与钢板的安全性于一体的假体,可提供术后即刻稳定,恢复椎间隙高度,使颈椎正常生理性能得以维持。可以作为治疗包括颈椎间盘突出、脊髓型颈椎病以及退行性颈椎失稳的一种选择。     

Radiological Assessment of the Effects of Anterior Cervical Discectomy and Fusion on Distraction of the Posterior Ligamentum Flavum in Patients with Degenerative Cervical Spines

BackgroundThis study aimed to assess the effects of anterior cervical discectomy and fusion (ACDF) on distraction of the posterior ligamentum flavum (LF) by increasing the intervertebral disc height and positioning a graft in patients with degenerative cervical spine disease.MethodsSixty-eight patients with degenerative cervical diseases who underwent single-level ACDF were included in the analysis. The intervertebral disc height, Cobb angle, and transverse thickness of the LF were measured, and magnetic resonance imaging was performed both preoperatively and 6 weeks postoperatively on each patient. Correlation analyses were performed to evaluate the relationships between age, sex, change in intervertebral disc height, Cobb angle, and position of the intervertebral implant according to the postoperative change in LF thickness. The position of the intervertebral implant was categorized as anterior, middle, or posterior. We also evaluated radiological effects according to the implant position.ResultsThe mean intervertebral disc height increased from 5.88 mm preoperatively to 7.49 mm postoperatively. The Cobb angle was 0.88° preoperatively and 1.43° postoperatively. Age (p = 0.551), sex (p = 0.348), position of cage (p = 0.312), pre- and postoperative intervertebral disc height (p = 0.850, p = 0.900), Cobb angle (p = 0.977, p = 0.460), and LF thickness (p = 0.060, p = 1.00) were not related to changes in postoperative LF thickness. Postoperative increase in disc height was related to Cobb angle (r = 0.351, p = 0.038). No other factors were significantly related. The position of the cage was not related with the change of Cobb angle (p = 0.91), LF thickness (p = 0.31), or disc height (p = 0.54).ConclusionsChange in the intervertebral disc height and the position of the intervertebral implant after ACDF did not affect the thickness of the LF after surgery in patients with degenerative cervical spine disease.     

Anterior Interbody Fusion with the BAK-Cage in Cervical Spondylosis

Summary BAK-C is a new autostabilizing interbody cage which is implanted during an anterior cervical procedure to provide stability to the motion segment and allow fusion to occur. Special intrumentation is provided with a bone collecting reamer. The system utilizes surgical site bone graft as the osteo-inductive material within the implant. Biomechanical testing indicates improved stability and animal studies show good fusion. The basic principle is distraction-compression using the tension forces of the annulus fibrosus. Operative material concerns a two years experience with 80 patients (101 levels), 72 with cervical radiculopathy, 8 with myelopathy. Clinical evaluation is assessed on a ten point analogue pain scale for neck and arm/shoulder pain, with neurological examination. Radiological evaluation includes dynamic X-rays, myelo-CT and MRI. Patients are re-evaluated at 1, 6, 12 months postoperatively. Results for neck and radicular pain is excellent, but neurological recovery for radiculopathy and myelopathy is quite different. Radiological results are also good with (except one case) no instability, no cage migration, no kyphosis, no pseudarthrosis. Bone fusion is assessed at 6 and 12 months. Complications are few with proper technique, mainly correct distraction, symmetrical endplate drilling and lateral X-ray control. Only one patient needed an early re-operation with additional miniplate fixation. Immediate stability with good clinical response and no graft morbidity are the advantages of this implant compared to conventional cervical interbody grafting techniques.     

Anterior Cervical Discectomy and Fusion Using Escherichia coli-Derived Recombinant Human Bone Morphogenetic Protein-2: A Pilot Study

BackgroundRecombinant human bone morphogenetic protein-2 (BMP-2) is an osteoinductive growth factor widely used in orthopedic surgery; it is also known to be associated with postoperative airway compromise or dysphagia when applied to anterior cervical discectomy and fusion (ACDF). However, there have been no reports on ACDF using Escherichia coli-derived BMP-2 (E.BMP-2) with hydroxyapatite (HA). This pilot study aimed to investigate the potential efficacy and safety of E.BMP-2 using HA as a carrier in ACDF prior to designing a larger-scale prospective study.MethodsPatients eligible for inclusion were those who underwent ACDF using 0.3 mg of E.BMP-2 with HA per segment for degenerative cervical disc disease between August 2019 and July 2020 and had at least 1 year of follow-up. Fusion rates were analyzed using computed tomography or flexion-extension radiographs. Visual analog scales for neck pain and arm pain and neck disability index were measured preoperatively and the final follow-up. In cases of cervical spondylotic myelopathy, modified Japanese Orthopaedic Association scores were also evaluated. Postoperative complications such as airway compromise, dysphagia, wound infection, neurologic deficit, hoarseness, heterotopic ossification, seroma, and malignancy were investigated.ResultsA total of 11 patients and 21 segments were analyzed. All clinical outcomes significantly improved at the final follow-up compared with the preoperative indices (p < 0.05). Only 1 case of dysphagia and no cases of airway compromise, wound infection, neurologic deficit, hoarseness, heterotopic ossification, seroma, or malignancy were observed during the follow-up period. Of the 21 segments, 15 segments showed solid fusion at 3 months after surgery, 4 segments at 6 months, and 1 segment at 12 months. Only 1 segment showed pseudoarthrosis, resulting in a fusion rate of 95.2%.ConclusionsThe outcomes of ACDF could be enhanced using 0.3 mg of E.BMP-2 with HA per segment. Based on this study, larger-scale prospective studies can be conducted to evaluate the efficacy and safety of E.BMP-2 in ACDF.