Anterior approaches to fusion of the cervical spine:: a metaanalysis of fusion rates
Anterior approaches to fusion of the cervical spine:: a metaanalysis of fusion rates
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DOI：
10.3171/spi.2007.6.4.298
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发表时间：
2007-04-01
影响因子：
2.8
通讯作者：
Haertl, Roger
中科院分区：
文献类型：
--
作者：
Fraser, Jusun F.;Haertl, Roger
对象。颈椎前路椎间盘切除术（ACD）、ACD合并椎间融合术（ACDF）、ACDF合并前路钢板系统置入术（ACDFP）、椎体切除术和椎体切除术合并钢板置入术均可用于颈椎融合。作者对1990年以后发表的研究进行了荟萃分析，这些研究报告了退行性疾病患者在1、2和3椎间盘水平上的融合率。21篇论文每篇包含至少25名患者的数据。在21项研究中，每项研究的平均临床随访时间均超过12个月，根据融合的影像学证据和融合节段的数量对结果进行评估。采用卡方检验和Fisher精确检验进行比较。患者平均年龄46.7岁，女性46.6%，平均随访时间39.6个月。研究纳入2682例患者，总融合率为89.5%。对于单椎间盘水平的疾病，ACD的融合率为84.9%，ACDF为92.1%，ACDFP为97.1% （p = 0.0002）。对于两椎间盘水平的疾病，ACDF的融合率为79.9%，ACDFP为94.6%，椎体切除术为95.9%，椎体切除术合并钢板置入术为92.9% （p = 0.0001）。对于三椎间盘水平的疾病，ACDF的融合率为65.0%，ACDFP为82.5%，椎体切除术为89.8%，椎体切除术合并钢板置入术为96.2% （p = 0.0001）。前钢板的使用显著改善了一级（p < 0.0001）、二级（p < 0.0001）和三级（p < 0.05） ACDF的融合。两节段ACDF与椎体切除术加钢板置入的融合率无显著差异。预期的融合率是指导手术决策的几个因素之一。颈椎前路减压融合导致高融合率。作者的研究结果表明，无论融合的节段数如何，使用颈椎前路钢板系统可显著提高融合率：对于双椎间盘水平的疾病，ACD与钢板系统或椎体切除术与钢板系统之间无显著差异。然而，对于三椎间盘水平的疾病，有证据表明椎体切除术加钢板置入比椎间盘切除术加钢板置入具有更高的融合率。
Object. Anterior cervical discectomy (ACD), ACD with interbody fusion (ACDF), ACDF with placement of an anterior plate system (ACDFP), corpectomy, and corpectomy with plate placement are used to fuse the cervical spine. The authors conducted a metaanalysis of studies published after 1990 in which fusion rates achieved with each procedure were reported for patients with degenerative disease at one, two, and three disc levels.Methods. Twenty-one papers each included data on at least 25 patients. In each of the 21 studies the average clinical follow up was more than 12 months, and the results were evaluated according to radiographic evidence of fusion and delineated by the number of levels fused. Chi-square and Fisher exact tests were used for comparisons. The mean age of the patients was 46.7 years, 46.6% were female, and the mean follow-up period was 39.6 months. The studies included 2682 patients and the overall fusion rate was 89.5%. For single disc-level disease, fusion rates were 84.9% for ACD, 92.1% for ACDF, and 97.1% for ACDFP (p = 0.0002). For two disc-level disease, fusion rates were 79.9% for ACDF, 94.6% for ACDFP, 95.9% for corpectomy, and 92.9% for corpectomy with plate placement (p = 0.0001). For three disc-level disease, fusion rates were 65.0% for ACDF, 82.5% for ACDFP, 89.8% for corpectomy, and 96.2% for corpectomy with plate placement (p = 0.0001). The use of anterior plates significantly improved fusion for one-level (p < 0.0001), two-level (p. < 0.0001), and three-level (p < 0.05) ACDF. There was no significant difference in fusion rates between two-level ACDF and corpectomy with plate placement.Conclusions. The anticipated fusion rate is one of several factors that may guide surgical decision making. Anterior cervical decompression and fusion results in high fusion rates. The results of the authors' study show that regardless of the number of levels fused, the use of an anterior cervical plate system significantly increases the fusion rate: For two-disc-level disease, there was no significant difference between ACD with a plate system or corpectomy with a plate system. For three-disc-level disease, however, the evidence suggests that corpectomy with plate placement is associated with higher fusion rates than discectomy with plate placement.