Techniques for cervical interbody grafting
Techniques for cervical interbody grafting
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DOI：
10.3171/2009.2.spine08723
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发表时间：
2009-08-01
影响因子：
2.8
通讯作者：
Resnick, Daniel K.
中科院分区：
文献类型：
--
作者：
Ryken, Timothy C.;Heary, Robert F.;Resnick, Daniel K.
Object.本系统评价的目的是使用循证医学来确定椎间植骨技术的有效性。使用与颈椎椎间植骨相关的MeSH标题和关键词查询国家医学图书馆和科克伦数据库。对摘要进行了审查，并选择了符合纳入标准的研究。指南小组汇编了一份证据表，总结了证据的质量（I-III类）。在专家共识会议上解决了关于证据等级的分歧。该小组根据苏格兰校际指导方针网络提出了包含强度程度的建议。通过美国神经外科医师协会/神经外科医师大会联合指南委员会的同行评议进行验证。从髂嵴采集的自体移植骨、从尸体髂嵴或腓骨采集的同种异体移植骨、或钛融合器和矩形融合器，使用或不使用自体移植物或替代物。在单节段或双节段颈椎前路椎间盘切除融合术（II类）后成功进行关节融合术。自体移植物、同种异体移植物或钛融合器的替代品包括聚醚醚酮融合器和碳纤维融合器（III类）。聚醚醚酮椎间融合器已成功用于颈椎前路椎间盘切除融合术中，可联合或不联合羟基磷灰石。重要的是，重组人骨形态发生蛋白-2的并发症发生率高达23-27%（特别是局部水肿），而标准方法的并发症发生率为3%。目前的证据不支持常规使用椎间植骨进行颈椎关节融合术。椎间植骨的多种策略已获得成功，II级证据支持使用自体植骨、同种异体植骨和钛融合器。(DOI：10.3171/2009.2.SPINE08723）
Object. The objective of this systematic review was to use evidence-based medicine to determine the efficacy of interbody graft techniques.Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical interbody grafting. Abstracts were reviewed and Studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through,in expert Consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgerons/Congress of Neurological Surgeons.Results. Autograft bone harvested from the iliac crest, allograft bone from either cadaveric iliac crest or fibula, or titanium cages and rectangular fusion devices, with or without the use of autologous graft or substitute. have been Successful in creating arthrodesis after 1- or 2-level anterior cervical discectomy with fusion (Class II). Altenatives to autograft, allograft, or titanium cages include polyetheretherketone cages and carbon fiber cages (Class III). Polyetheretherketone cages have been used successfully with or Without hydroxyapatite for anterior cervical discectomy with fusion. Importantly, recombinant human bone morphogenic protein-2 carries a complication rate of up to 23-27% (especially local edema) compared with 3% for a standard approach.Conclusions. Current evidence does not support the routine use of interbody grafting for cervical arthrodesis. Multiple strategies for interbody grafting have been Successful with Class II evidence Supporting the use of autograft, allograft, and titanium cages. (DOI: 10.3171/2009.2.SPINE08723)