Anterior fusion for unstable lower cervical spine / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the clinical outcome of anterior fusion for unstable lower cervical spine.</p><p><b>METHODS</b>From October 2000 to October 2004, anterior fusion were performed for 67 cases with unstable lower cervical spine with corresponding clinical manifestations. There were 38 males and 29 females with an average age of 33 years. Instability of lower cervical spine was radiographically determined by sagittal plane displacement between 2 cervical vertebrae of more than 3.5 mm or relative sagittal plane angulation greater than 11 degrees on maximal lateral flexion and extension films. Anterior interbody fusion methods included bone grafting with plate fixation or cage. JOA rating system was used for spine cord function assessment.</p><p><b>RESULTS</b>All patients were followed up for an average period of 14 months. Solid fusion was achieved for all operated levels. The majority of the patients got a satisfactory relief of preoperative symptoms. JOA scores for cord function improved from preoperative 10.15 to postoperative 14.95 with statistical difference (P < 0.05). Complications included screws loosing and backout in 2 cases. Revision surgery were performed with uneventful recovery.</p><p><b>CONCLUSION</b>Satisfactory clinical outcome can be achieved by proper selection of anterior fusion methods for patients with unstable lower cervical spine.</p>

A comparative study on maintenance of disc height by different anterior cervical fusion methods / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the effect of autograft, cage and autograft plus internal fixation with plate on maintenance of disc height and recovery of spinal cord function.</p><p><b>METHODS</b>From March 1998 to June 2004, 117 cervical spondylotic patients who received anterior fusion surgery were reviewed. There were 65 males and 52 females with an average age of 57 years (range from 31 to 72 years). One level was involved in 91 patients, and two levels in 26. Fusion methods included autogenous tri-cortical iliac bone grafting alone in 31 patients, cage with autograft bone in 38 and autogenous tri-cortical iliac bone grafting combined with self-locking plate in 49. The measured fusion length was determined as the distance from the midpoint between the anterior and posterior aspects of the superior endplate of the top level of the fusion to the midpoint of the inferior endplate of the bottom level of the bottom level of the fusion. JOA rating criteria was used for cord function evaluation. One-way variation analysis was used to compare the disc height loss and cord function among the 3 groups.</p><p><b>RESULTS</b>All patients were followed-up for an average period of 23 months (range, 13 to 59 months). At final follow- up, disc height loss averaged 1.94 mm in autogenous tri-cortical iliac bone grafting group, greater than that in the other two groups (1.48 mm in cage group and 1.25 mm in instrumented group) with statistical significance. Recovery of spinal cord function was satisfactory in all groups at one year postoperatively with no statistical difference. Three implants failure occurred in self-locking plate group and was salvaged with uneventful recovery.</p><p><b>CONCLUSIONS</b>In anterior cervical fusion surgery, maintenance of disc height could be achieved by proper application of cage or internal fixation with plate.</p>