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Titolo:
ANTERIOR INTERBODY FUSION FOR CERVICAL-SPINE INJURIES - INDICATIONS, IMPLANTS, TECHNIQUE AND RESULTS
Autore:
BLAUTH M; SCHMIDT U; BASTIAN L; KNOP C; TSCHERNE H;
Indirizzi:
HANNOVER MED SCH,UNFALLCHIRURG KLIN D-30623 HANNOVER GERMANY
Titolo Testata:
Zentralblatt fur Chirurgie
fascicolo: 8, volume: 123, anno: 1998,
pagine: 919 - 929
SICI:
0044-409X(1998)123:8<919:AIFFCI>2.0.ZU;2-X
Fonte:
ISI
Lingua:
GER
Soggetto:
PLATE FIXATION; FRACTURE-DISLOCATIONS; STABILIZATION;
Keywords:
CERVICAL SPINE; ANTERIOR INTERBODY FUSION; INJURIES; OPERATIVE TECHNIQUE; BIOMECHANICS; PLATE FIXATION; RESULTS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
40
Recensione:
Indirizzi per estratti:
Citazione:
M. Blauth et al., "ANTERIOR INTERBODY FUSION FOR CERVICAL-SPINE INJURIES - INDICATIONS, IMPLANTS, TECHNIQUE AND RESULTS", Zentralblatt fur Chirurgie, 123(8), 1998, pp. 919-929

Abstract

Lower cervical spine injuries with instability of the anterior and/orposterior column can be treated by anterior interbody fusion and plate fixation. Plates available for anterior instrumentation of the lowercervical spine can be divided into locking or non-locking systems with uni- or bicortical screw purchase. Our biomechanical comparative testing of different screw fixation systems demonstrates improved stability with the use of bicortical purchase. Clinical studies, however, have proven high fusion rates without loss of correction and a low implant related morbidity with the use of unicortical as well of bicortical plate systems. Correct reduction and intraoperative positioning of theunstable cervical spine is crucial to avoid implant related complications. Also, limitations of anterior instrumentation for the treatment of specific lesions of the lower cervical spine have to be considered,e.g. in complex lesions with axial instability or in fracture dislocations with ankylosing spondylitis. Changes or alterations of adjacent segments can be reduced by the use of plates with correct lengths, contact of uninjured adjacent discs with implants should be avoided. A comparative analysis of two patient collectives - 89 patients (1972-1983) and 102 patients (1987-1994), all of them treated with bicortical plate fixation - revealed different results in terms of implant failure,operative reduction and loss of correction. All but one surgical fusions had healed radiologically. Implant related complications during the first 3 months after the inital operation were lower in the latter group, only 3 out of 102 patients (3 %) with implant loosening versus 7out of 89 patients (8 %) with implant breakage or loosening required surgical revision. In all cases technical errors could be detected. Clinical follow-ups with personal examination was performed in 144 patients: 57 of 72 survivors of series I (79 %) after an average time of 11years 9 months and 87 out of 94 survivors of series II (85 %), The radiologic examination revealed 2 patients with screw breakage in seriesI, one patient with an asymptomatic implant loosening in series II. Only one case was observed with a loss of correction after loosened andearly removed hardware. In all other patients there was no differenceof radiologic angles between postoperative X-ray and followup. 16 patients, 12 of series I, 4 of series II, were fused in a kyphotic position after insufficient preoperativ reduction. Radiologic alterations ofadjacent segments, i.e. spondylophyts or ''spontaneous'' fusions, were observed in more than 50 % of all patients of both series. However, complaints or persistent pain did not correlate with radiologic findings. Also;in both series there was a high percentage of patients with mild, residual neck pain in spite of a very good radiologic result. Only in a very few cases the complaints had to be treated by drugs.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 14/07/20 alle ore 17:35:22