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Jan Stulik Tobias Rainer Pitzen Jan Chrobok Sabine Ruffing Jörg Drumm Laurentius Sova Ravel Kucera Tomas Vyskocil Wolf Ingo Steudel 《European spine journal》2007,16(10):1689-1694
Anterior cervical plate fixation is an approved surgical technique for cervical spine stabilization in the presence of anterior
cervical instability. Rigid plate design with screws rigidly locked to the plate is widely used and is thought to provide
a better fixation for the treated spinal segment than a dynamic design in which the screws may slide when the graft is settling.
Recent biomechanical studies showed that dynamic anterior plates provide a better graft loading possibly leading to accelerated
spinal fusion with a lower incidence of implant complications. This, however, was investigated in vitro and does not necessarily
mean to be the case in vivo, as well. Thus, the two major aspects of this study were to compare the speed of bone fusion and
the rate of implant complications using either rigid- or dynamic plates. The study design is prospective, randomized, controlled,
and multi-centric, having been approved by respective ethic committees of all participating sites. One hundred and thirty-two
patients were included in this study and randomly assigned to one of the two groups, both undergoing routine level-1- or level-2
anterior cervical discectomy with autograft fusion receiving either a dynamic plate with screws being locked in ap - position
(ABC, Aesculap, Germany), or a rigid plate (CSLP, Synthes, Switzerland). Segmental mobility and implant complications were
compared after 3- and 6 months, respectively. All measurements were performed by an independent radiologist. Mobility results
after 6 months were available for 77 patients (43 ABC/34 CSLP). Mean segmental mobility for the ABC group was 1.7 mm at the
time of discharge, 1.4 mm after 3 months, and 0.8 mm after 6 months. For the CSLP- group the measurements were 1.0, 1.8, and
1.7 mm, respectively. The differences of mean segmental mobility were statistically significant between both groups after
6 months (P = 0.02). Four patients of the CSLP-group demonstrated surgical hardware complications, whereas no implant complications were
observed within the ABC-group (P = 0.0375). Dynamic plate designs provided a faster fusion of the cervical spine compared with rigid plate designs after prior
spinal surgery. Moreover, the rate of implant complications was lower within the group of patients receiving a dynamic plate.
These interim results refer to a follow-up period of 6 months after prior spinal surgery. Further investigations will be performed
2 years postoperatively. 相似文献
2.
Disc replacement using Pro-Disc C versus fusion: a prospective randomised and controlled radiographic and clinical study 总被引:4,自引:0,他引:4
A. Nabhan F. Ahlhelm T. Pitzen W. I. Steudel J. Jung K. Shariat O. Steimer F. Bachelier D. Pape 《European spine journal》2007,16(3):423-430
Anterior cervical discectomy and fusion (ACDF) may be considered to be the gold standard for treatment of symptomatic degenerative
disc disease within the cervical spine. However, fusion of the segment may result in progressive degeneration of the adjacent
segments. Therefore, dynamic stabilization procedures have been introduced. Among these, artificial disc replacement by disc
prosthesis seems to be promising. However, to be so, segmental motion must be preserved. This, again, is very difficult to
judge and has not yet been proven. The aim of the current study was to first analyse the segmental motion following artificial
disc replacement using a disc prosthesis. A second aim was to compare both segmental motion as well as clinical result to
the current gold standard (ACDF). This is a prospective controlled study. Twenty-five patients with cervical disc herniation
were enrolled and assigned to either study group (receiving a disc prosthesis) or control group (receiving ACDF, using a cage
with bone graft and an anterior plate.) Radiostereometric analysis was used to quantify intervertebral motion immediately
as well as 3, 6, 12 and 24 weeks postoperatively. Further, clinical results were judged using visual analogue scale and neuro-examination.
Cervical spine segmental motion decreased over time in the presence of disc prosthesis or ACDF. However, the loss of segmental
motion is significantly higher in the ACDF group, when looked at 3, 6, 12 and 24 weeks after surgery. We observed significant
pain reduction in neck and arm postoperatively, without significant difference between both groups (P > 0.05). Cervical spine disc prosthesis preserves cervical spine segmental motion within the first 6 months after surgery.
The clinical results are the same when compared to the early results following ACDF. 相似文献
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Die Unfallchirurgie - Densfrakturen zählen zu den häufigsten Verletzungen der Wirbelsäule. Neben den klassischen Verfahren kann die dorsale C1-C2-Fusion nach Goel-Harms als... 相似文献
5.
T. Pitzen D. Barbier F. Tintinger W. Steudel M. Strowitzki 《European spine journal》2002,11(5):494-499
There is no consensus over whether screw fixation for anterior cervical plating should include the posterior cortical shell of the vertebral bodies or not. Thus, the purpose of this study was to investigate the function of the posterior cortical shell with respect to maximal screw torque and pullout force. Twenty-four fresh frozen human cervical vertebrae coming from six spinal segments C4-C7 were used. They were scanned for bone mineral density (BMD) and then assigned to two groups with comparable bone density and segmental distribution. The posterior longitudinal ligament was resected carefully and two parallel burr holes were drilled into each vertebral body. The posterior cortical shell was removed in one burr hole, using a 6-mm steel burr, producing a shallow excavation with a depth of approximately 2 mm. An ABC screw was inserted into each burr hole. The screw to be inserted into the hole with the posterior excavation was called "monocortical". In contrast, the contralateral screw was called "bicortical". Peak torque was measured in one group, while pullout force was analyzed using the specimens of the second group. Mean value and standard deviation were calculated for peak torque and pullout force with respect to the type of fixation. A paired t-test was used to determine the effect of fixation type on peak torque and pullout force. Pearson moment correlation coefficients were calculated to determine the effect of BMD on peak torque and pullout force with respect to whether the screw was "mono- or bicortical". A 95% level of significance was used for all tests. No significant differences for peak torque and pullout force could be found comparing monocortical and bicortical screw fixation. However, for both monocortical and bicortical screw fixation, a positive correlation was seen for peak torque versus BMD and for pullout force versus bone mineral density, respectively. The importance of the posterior cortical shell for screw pullout force and screw peak torque seems to be negligible. In constrast, BMD greatly influences both peak torque and pullout force for both types of fixation. 相似文献
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Pitzen T. Al Kahwagi B. Ostrowski G. Welk T. Pckler-Schninger C. Drumm J. Ruf M. 《Trauma und Berufskrankheit》2018,20(3):141-149
Pediatric injuries in the region of the cervical spine are rare. Timely diagnostics and a rapid and consistent treatment are essential. This is probably the best initial situation to avoid delayed sequelae as these would mean lifelong impairment for the child. Therefore, this article deals with the acute treatment and delayed sequelae of pediatric injuries of the cervical spine. 相似文献
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T. Pitzen Hans-Joachim Wilke Wolfhard Caspar Lutz Claes Wolf-Ingo Steudel 《European spine journal》1999,8(5):382-387
The purpose of this combined study was to evaluate the stability and safety of a new monocortical screw-plate system for
anterior cervical fusion and plating (ACFP) according to Caspar in comparison with classical bicortical fixation. In the biomechanical
part of the study two groups, each comprising six fresh human cadaveric spines (C4–C7), matched for bone mineral density,
additionally resulting in almost the same mean age, were used. Range of motion and neutral zone were analyzed in flexion-extension,
rotation (left, right) and lateral bending (left, right) using pure moments of ± 2.5 Nm for each specimen in the intact state,
after discectomy at C5/6 and after discectomy at C 5/6 followed by bone grafting plus plating (Caspar plates), with either
monocortical or bicortical screws. For all three motion planes, no significant difference could be found between the new monocortical
and the bicortical fixation techniques. The clinical part of the study was performed as a prospective study on 30 patients
suffering from symptomatic degenerative cervical disc disease in one segment. At the latest follow-up, no hardware- or graft-related
complications were seen in any of the patients. Following these findings monocortical screw fixation can be recommended for
the majority of anterior cervical fusion and plating procedures in degenerative disease, making the procedure quicker, easier,
and safer. Bicortical screw fixation still has specific indications for multilevel stabilization, poor bone quality (osteoporosis,
rheumatoid disease – as bicortical oversized rescue screw), unstable spines (trauma, tumour) and in particular for the realignment
of kyphotic deformities (restoration of the normal lordotic curve). Due to the design of the study the results apply only
to surgical treatment of monosegmental degenerative disc disease at the time.
Received: 28 November 1998 Revised: 19 March 1999 Accepted: 29 May 1999 相似文献