Anterior cervical corpectomy and strut graft fusion using a different method.

BACKGROUND CONTEXT: Strut graft fusion after corpectomy is frequently indicated for certain pathologies in the cervical spine. The "key-hole" technique and "dove-tail" technique are the popular methods used to insert the strut graft at present. Segmental collapse secondary to seating of the graft on cancellous bone and cord injury from placement or dislodgement the graft are our concerns. Our method was designed to solve these possible problems without affecting the arthrodesis. PURPOSE: To evaluate the results of this method that allows the graft to seat on both the hard end plate and cancellous bone of the upper and lower contacting vertebrae in a easy and safe way after varying levels of corpectomy in the cervical spine. STUDY DESIGN: A retrospective clinical and radiographic study conducted by an independent observer was performed on 23 patients treated with this different strut grafting method after cervical corpectomy, with at least 2 years of follow-up. PATIENT SAMPLE: A total of 23 patients from 1983 to 1994 underwent fusion using our strut grafting method with fibular allograft packed with autogenous bone. No augmented internal instrumentation was used in all these patients. The patients with an incomplete record or less than 2 years of follow-up were excluded beforehand. OUTCOME MEASURES: Clinical outcome was assessed by a score based on three factors: neck pain, dependence on medicine and ability to return to work. The total score of these factors was seven. A score from 0 to 3 was defined as satisfactory, and a score from 4 to 7 was defined as unsatisfactory. The result of graft fusion, collapse of interbody height and loss of lordotic angle corrected by the graft were evaluated through the radiographic studies. METHODS: The operative technique creates a notch in the anterior cortex and end plate of the respective superior and inferior vertebraes. Cylinder allograft filled with autogenous cancellous bone was used as bone graft for all patients. The bone graft is cut with corresponding pegs at both ends. The graft is inserted into the corpectomy space with the pegs inserted into the notches and the remainder of the graft placed onto the preserved superior and inferior bony end plates. RESULTS: Twenty patients achieved successful fusion (87%). On average, the loss of anterior and posterior interbody height was 2.79 mm and 2.93 mm, respectively. The average loss of lordotic correction was 2.83 degrees. Eighty-three percent achieved satisfactory clinical outcomes. There were no neurologic injuries encountered during the operation. Partial graft dislodgment occurred in two patients (8.7%). CONCLUSIONS: This different method of strut grafting after cervical corpectomy has proven its safety and efficacy in its fusion and clinical results.     

Anterior corpectomy and fusion for severe ossification of posterior longitudinal ligament in the cervical spine

Between May 2002 and October 2006, 19 patients (17 men and 2 women; average age 57.2; range 47-71 years) received anterior corpectomy and fusion for severe ossification of the posterior longitudinal ligament (OPLL) in our department. Preoperative radiological evaluation showed the narrowing by the OPLL exceeded 50% in all cases, and OPLL extended from one to three vertebrae. We followed-up all patients for 12-36 months (mean 18 months). The Japanese Orthopaedic Association (JOA) score before surgery was 9.3 +/- 1.8 (range 5-12) which significantly increased to 14.2 +/- 1.3 (range 11-16) points at the last follow-up (P < 0.01). The improvement rate (IR) of neurological function ranged from 22.2-87.5%, with a mean of 63.2% +/- 15.2%. The operation also provided a significant increase in the cervical lordosis and the cord flatting rate (P < 0.01). No severe neurological complication developed. We therefore concluded that anterior decompression and fusion was effective and safe in the treatment of the selected patients, although OPLL exceeded 50% diameter of the spinal canal.     

Anterior interbody fusion using the cervical spine locking plate

Surgical Principles The Cervical Spine Locking Plate system (CSLP) is designed to perform anterior fusions of the cervical and upper thoracic spine. The screws are locked in the H shaped plate providing intrinsic angle stability. Early osseous integration is enhanced by titanium plasma spray coating and by the hollow and perforated design of the screws. These features enhance the primary and secondary stability of the fixation. Therefore the penetration of the posterior cortex of the vertebra with the screws is not necessary, which is a decisive asset compared to conventional plate systems. This essentially diminishes the intraoperative risks. The primary stability is superior to that of conventional plate systems as the screws are tightly locked into the plate in convergence.     

Vertebra plana and eosinophilic granuloma of the cervical spine in children

Eosinophilic granuloma of the cervical spine in children is a rare lesion which presents both diagnostic and therapeutic problems. The report describes three additional cases. Open biopsy is recommended instead of attempted needle aspiration in children. Laminectomy is likely to result in spinal deformity, and is not advised unless a second stage fusion is planned. Radiotherapy is effective in controlling the lesion. The ultimate outcome is usually good.     

Anterior interbody fusion of the cervical spine with coralline hydroxyapatite.

STUDY DESIGN: A nonrandomized, retrospective human study of patients requiring anterior discectomy and reconstruction from C3 to T1. The pattern of incorporation, presence or absence of disc space collapse, maintenance of correction, and clinical outcomes were considered. OBJECTIVE: To determine the efficacy of coralline hydroxyapatite as a bone replacement in anterior interbody fusions of the cervical spine used in conjunction with rigid plate fixation. SUMMARY OF THE BACKGROUND DATA: Autograft is the gold standard for anterior interbody fusion of the cervical spine. Reported complication and morbidity rates with the use of autograft are as high as 21%. Using allograft instead of autograft presents numerous problems including lower rates of fusion. Other bone substitutes such as ceramics and polymethylmethacrylate are ineffective for fusion. METHODS: Twenty-six skeletally mature patients underwent anterior decompression, stabilization, microdiscectomy, and reconstruction with Pro Osteon 200 (Interpore Cross International, Irvine, CA) coralline hydroxyapatite and AO anterior cervical locking plates. Iliac crest autograft, local bone, and allograft were not used. RESULTS: The minimum follow-up period was 2 years (average, 30 months). There was no evidence of plate breakage, screw breakage, resorption of the implant, or pseudarthrosis. Two patterns of incorporation were identified. The implant incorporated totally in 100% of the disc spaces. Average hospital stay was 1.6 days. The average decrease in pain was 75.8%. There was no evidence of nonunion. CONCLUSIONS: The use of Pro Osteon 200 with rigid anterior plating seems promising as a bone replacement in the cervical spine. The incorporation rate is exceedingly high, and the complication rate nonexistent.     

保留椎体后壁的前路减压术治疗多节段颈椎病

目的探讨保留椎体后壁的颈前路减压融合术对多节段脊髓型颈椎病的疗效,并与传统的椎体次全切除术比较。方法2006年3月~2007年4月,收治多节段脊髓型颈椎病患者36例,其中男22例,女14例,年龄为38~72岁,平均55.61岁。以上病例随机分成2组,每组18例,分别行传统的椎体次全切除术和保留椎体后壁的颈前路椎体次全切除植骨融合术。比较两组手术时间、出血量、并发症、术后JOA评分、植骨融合率等各项指标。结果两种术式术后3个月植骨融合率均为100%,JOA评分改善无明显差异。保留椎体后壁组手术时间短,出血少。结论保留椎体后壁的颈前路减压融合术具有手术时间短、出血少、手术风险小、减压彻底等优点,对颈椎椎体结构干扰破坏小,植骨融合率高,术后并发症少,是一种比传统的椎体次全切除植骨融合术更理想的术式。     

Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical spondylosis: a systematic review

Introduction  

There is considerable controversy as to which technique is best option for reconstruction after multilevel anterior decompression for cervical spondylosis. The aim of this study was to compare the clinical and radiographic results and complications of anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF) in the treatment of multi-level cervical spondylosis.     

前路椎体次全切除减压及带锁钢板固定治疗脊髓型颈椎病

目的 探讨带锁钢板在颈前路开槽式减压植骨治疗多节段脊髓型颈椎病中的应用价值。方法５５例脊髓型颈椎病患者,男性３６例,女性１９例,年龄平均５１．５岁,病程平均１３个月。病变累及２个功能节段者４７例,累及３个功能节段者８例,术前ＪＯＡ评分平均为８．３分。病变部位全部行颈前椎体次全切除减压,自体髂骨植骨,带锁钢板固定术。结果５１例获随访,平均２６个月,植骨全部于术后１２～１６周骨性愈合,术后恢复之椎间高     

前后路矫形融合术治疗胸腰段/腰段青少年特发性脊柱侧凸(PUMC Ⅰb/Ⅰc/Ⅱd1型)

目的比较前后两种入路及手术方法治疗特发性胸腰段／腰段脊柱侧凸的疗效。方法青少年特发性脊柱胸腰段／腰段侧凸（PUMC Ⅰb，Ⅰc，Ⅱd1型）患者28例，分为两组。A组16例，平均14．88岁，行前路短节段矫形融合术；B组12例，平均15．50岁，行后路、椎弓根系统矫形融合术。两组均采用第三代坚强矫形内固定器械。比较两组术前一般资料和术中情况，并通过X线参数，比较两种手术的矫形效果和躯干平衡的矫正情况。结果两组术前资料无显著差异，术后均无严重手术并发症，融合效果满意。A组手术时问、术中出血及输血量、内固定材料花费明显少于B组；A组平均融合4．25个节段，B组平均融合5．95个节段。随访时间12-47个月，A组术后冠状面矫正率是82％，随访时72％；B组术后冠状面矫正率是74％，随访时70％。矢状面矫形效果均满意，两组无显著性差异；A组术后即刻躯干偏移矫正不如B组，但随访时，两组无差异。两组在矫正顶椎旋转和顶椎偏移方面无显著差异。结论前路矫形和后路椎弓根系统矫形融合术治疗轻中度胸腰段／腰段青少年特发性脊柱侧凸，均可获得满意的矫形效果，但前路融合可缩短手术时间和减少术中出血、输血量，并能保留较多运动节段。     

ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗多节段脊髓型颈椎病

目的探讨颈前路椎体次全切除减压融合术(ACCF)联合颈前路减压zero-p椎间植骨融合内固定术治疗多节段脊髓型颈椎病的临床疗效。方法回顾性分析自2016-05—2017-07采用ACCF联合颈前路减压zero-p椎间植骨融合内固定术治疗的30例多节段脊髓型颈椎病,比较术前、术后1周及末次随访时JOA评分、颈椎Cobb角、椎间隙高度。结果30例均顺利完成手术并获得完整随访,随访时间平均21.6个月,切口均一期愈合,植骨均骨性愈合,无内固定松动、移位、断裂、伤口感染、声音嘶哑及神经功能加重等并发症。术后1例出现脑脊液漏,2例出现吞咽不适,非手术治疗后均治愈。术后1周与末次随访时JOA评分、颈椎Cobb角、椎间隙高度较术前均明显改善,差异有统计学意义(P<0.05)。末次随访时根据JOA评分改善率评定综合疗效:优12例,良14例,可4例。结论ACCF联合颈前路减压zerop椎间植骨融合内固定术治疗多节段脊髓型颈椎病安全可靠,能够有效地恢复椎间隙高度和颈椎生理曲度。     

颈前路椎体次全切除联合椎间隙减压融合治疗多节段脊髓型颈椎病

目的:探讨多节段颈椎病颈前路椎体次全切除联合椎间隙减压融合内固定术的疗效。方法 :对2012年10月至2014年6月行颈椎前路治疗的28例脊髓型颈椎病的临床资料进行回顾性分析,其中男18例,女10例;年龄45~77(60.11±9.37)岁;27例患者病变累及3个节段,1例累及4个节段;术前JOA评分为8.89±1.87,拟融合节段Cobb角为(4.87±4.56)°,颈椎曲度为(11.68±1.25)°,均行颈椎前路椎体次全切除联合椎间隙减压融合内固定术。通过影像学资料测量术后1、12个月时的融合节段Cobb角、颈椎曲度,并采用JOA评分评价疗效。结果:手术时间120~205 min,平均163 min;术中出血量100~300 ml,平均198 ml;术后1例患者出现声音嘶哑,术后3周恢复正常;1例出现饮水呛咳,术后1周恢复正常。28例患者均获得随访,时间12~24(18.46±3.20)个月。术后12个月植骨椎间隙均获骨性愈合,内固定物位置良好。术后1、12个月时融合节段Cobb角与颈椎曲度及JOA评分均较术前明显改善(P0.05)。术后12个月JOA评分改善率为(46.46±20.26)%,手术疗效根据改善率评定:优12例,良14例,好转2例。结论:颈椎前路椎体次全切除联合椎间隙减压融合内固定术治疗多节段颈椎病效果满意。     

前路椎体次全切除减压植骨融合内固定治疗交感型颈椎病

目的总结和分析前路椎体次全切除减压、植骨融合内固定治疗交感型颈椎病的临床效果.方法2001年12月～2007年1月共收治经保守治疗无效、症状严重的交感型颈椎病患者23例,影像学资料显示患者均有颈椎间盘退变和骨质增生,8例伴有颈椎不稳,1例有先天性骨结构异常,均采用手术治疗,行前路单个或多个(≤3)椎体次全切除,彻底清除增生的骨赘和退变椎间盘,用充填有自体椎体碎骨的钛笼或自体髂骨椎间融合,钛板螺钉固定重建颈椎稳定性.根据术后X线片、JOA评分和临床交感神经症状改善情况综合评定手术治疗效果.结果手术时间75～150 min,术中出血量30～350 ml,平均70ml.随访3～36个月,平均13.5个月,其中7例术后交感神经刺激症状全部消失,12例主要交感神经症状消失,3例症状改善,1例症状无变化,有效率为95.7%,优良率为82.6%.JOA评分术前平均10.2±1.1分,术后3个月时平均14.3±1.3分,二者有统计学差异(P＜0.01),平均神经功能改善率为59.4%;13例术后10个月复查X线片示钛笼或髂骨块均与上下椎体达骨性融合,无钛板螺钉松动、断裂、移位和钛笼沉降等并发症发生.结论对于保守治疗无效、症状严重的交感型颈椎病,采用前路椎体次全切除减压植骨融合内固定治疗可取得较好效果.     

Anterior cervical dynamic ABC plating with single level corpectomy and fusion in forty-two patients

STUDY DESIGN: Forty-two consecutive patients undergoing dynamic ABC plated one-level ACF utilizing iliac crest autograft (38 patients) and fibula allografts (four patients) were evaluated. The unique ABC slotted plate design allows for up to 10 mm of cephalad and 10 mm of caudad plate migration. OBJECTIVES: To evaluate the incidence and etiology of complications in forty-two patients undergoing anterior cervical dynamic ABC plating (Aesculap, Tuttlingen, Germany), during one level anterior corpectomy with fusion (ACF). SETTING: New York, USA. METHODS: Serial dynamic X-ray and 2 Dimensional CAT Scan (2D-CT) studies, obtained 3, 6, and up to 12 months postoperatively, in 42 patients documented the presence of fusion or complications including plate or graft extrusion or pseudarthrosis. RESULTS: Four (9.5%) of 42 patients developed postoperative plate or graft-related complications during the average follow up interval of 34 months. One patient, with a plate/graft extrusion, required a second two level ACF with posterior wiring and fusion (PWF). Two patients with pseudarthroses and one patient with a delayed iliac crest strut fracture required secondary PWF. CONCLUSIONS: Effective arthrodesis and a low incidence of complications following one level ACF performed utilizing dynamic ABC plates were attributed to reduced stress shielding and greater graft compression afforded by the unique plate design. Applying dynamic ABC plates for one level ACF was biomechanically advantageous with low morbidity.