Abstract
The aim of this study was to investigate n-HA/PA66 strut subsidence after one-level in Anterior cervical corpectomy decompression and fusion (ACCF) and its effect on treatment outcomes to better understand the underlying mechanism and related risk factors. In total, 56 patients undergoing ACCF using n-HA/PA66 struts were analysed retrospectively. After a 12-month follow-up, the height of the fused segments and fused intervertebral heights were measured, the neurological findings were evaluated using the Japanese Orthopedic Association (JOA) and axial pain was assessed using a Visual Analogue Scale(VAS). Subsidence was defined as a decrease in the height of the fused segments or the fused intervertebral body greater than 3 mm compared with that on postoperative day one, and all patients were assigned to the n-HA/PA66 strut subsidence and control groups. In total, 45 patients experienced n-HA/PA66 strut subsidence during the postoperative (3 ± 2.42/3.11 ± 2.01) months. No significant differences were observed in sex, age, hospitalization time, surgical haemorrhage,bone mineral density (BMD), or height in the n-HA/PA66 strut group. The JOA and VAS of neck pain in the control group improved more than those in the subsidence group, suggesting that subsidence might be correlated with poor improvement of neurological function. In conclusion, n-HA/PA66 strut subsidence is a common complication after ACCF, and the reduced height of the postoperative fused segments and the height reduction in the postoperative fused intervertebral bodies are independent risk factors of n-HA/PA66 strut subsidence.
Highlights
ACCF is considered a safe and effective surgical procedure for the treatment of more than one level of cervical degenerative lesions, multiple cervical spondylotic myelopathy(CSM), while providing direct decompression, maintaining cervical involvement and providing the adjacent segment stability[1,2,3]
The purpose of this study was to investigate the factors related to n-HA/PA66 strut subsidence and its effect on cervical neurological function
All patients manifested disturbances associated with myelopathy, which was verified by radiographic data, including X-ray, magnetic resonance images (MRI), and computed tomography (CT) as necessary
Summary
ACCF is considered a safe and effective surgical procedure for the treatment of more than one level of cervical degenerative lesions, multiple cervical spondylotic myelopathy(CSM), while providing direct decompression, maintaining cervical involvement and providing the adjacent segment stability[1,2,3]. Compared with the traditional iliac bone transplant, a titanium mesh cage (TMC) using an n-HA/PA66 strut with a locking titanium plate can reduce long-term complications in the bone graft area and complications of TMC subsidence. Due to the popularity of the n-HA/PA66 strut, surgeons have gradually noted that the drawbacks, such as long-term bony fusion and subsidence. The incidence of n-HA/PA66 strut subsidence which could lead to postoperative yellow ligament folds, cervical kyphosis, and neural foramen stenosis, was reported to be 2.86–19.68%7,8,11,12. No study has investigated n-HA/PA66 strut and its potential risk factors of subsidence in one-level corpectomy in ACCF. The purpose of this study was to investigate the factors related to n-HA/PA66 strut subsidence and its effect on cervical neurological function
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