中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (48): 7175-7184.doi: 10.3969/j.issn.2095-4344.2016.48.005
• 脊柱植入物 spinal implant • 上一篇 下一篇
前路颈椎间盘切除和椎体次全切除植骨融合治疗临近两椎节脊髓型颈椎病
沈 强1，丁 浩1，朱宗昊1，朱 亮1，魏小康1，贺旭峰2
- 1上海交通大学附属上海市第一人民医院骨科，上海市 200080；2上海中医药大学附属曙光医院创伤科，上海市 200025
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修回日期:2016-09-12出版日期:2016-11-25发布日期:2016-11-25 -
作者简介:沈强，男，1962年生，山东省人，汉族， 1985年第二军医大学毕业，博士，主任医师，教授，研究方向为脊柱外科。 -
基金资助:上海市科技支撑项目(12441900702)
Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for treating two-level contiguous cervical spondylotic myelopathy
Shen Qiang1, Ding Hao1, Zhu Zong-hao1, Zhu Liang1, Wei Xiao-kang1, He Xu-feng2
- 1Department of Orthopedic Surgery, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai 200080, China; 2Department of Traumatology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200025, China
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Revised:2016-09-12Online:2016-11-25Published:2016-11-25 -
About author:Shen Qiang, M.D., Chief physician, Professor, Department of Orthopedic Surgery, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai 200080, China -
Supported by:The Key Project for Medical Science from the Shanghai Committee of Science and Technology of China, No.12441900702
摘要：
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文题释义：
前路颈椎间盘切除植骨融合：是指自颈部前方经过颈前内脏鞘与血管鞘间隙显露颈椎前方，在两侧颈长肌之间，切除病变椎间隙的前纵韧带，纤维环，髓核，及软骨终板，并切除突入椎管的髓核和椎体后缘增生压迫脊髓的骨赘，达到脊髓前方减压后，该椎间隙植骨融合的手术方式。
前路颈椎椎体次全切除植骨融合：是指自颈部前方经过颈前内脏鞘与血管鞘间隙显露颈椎前方，在两侧颈长肌之间，切除相邻的病变椎间隙以及中间的部分椎体，并切除突入椎管的髓核和椎体后缘增生压迫脊髓的骨赘，达到脊髓前方减压后，该椎间隙和椎体的开槽区域内植骨融合的手术方式。
摘要
背景：前路颈椎间盘切除植骨融合和前路颈椎椎体次全切除植骨融合广泛地被应用于治疗脊髓型颈椎病，此2种方法在治疗邻近两椎节连续性脊髓压迫颈椎病方面缺少长期随访的临床疗效和影像学比较研究。
目的：确定前路颈椎间盘切除植骨融合和前路颈椎椎体次全切除植骨融合治疗连续双椎节脊髓型颈椎病临床疗效和放射影像学远期差异。
方法：于2006年12月至2009年12月在上海交通大学附属上海市第一人民医院收集80例连续双椎节脊髓型颈椎病患者，随机等分为2组，分别接受前路颈椎间盘切除植骨融合和前路颈椎椎体次全切除植骨融合治疗，通过5年随访比较2组临床疗效和影像学方面的差异。
结果与结论：2组患者随访时间62-98个月，平均83.6个月。5年随访期间，2组患者日本整形外科学会评分、目测类比评分、Odom’s评分、植骨融合率和并发症方面差异无显著性意义，且2组患者颈椎Cobb角和颈椎手术椎节段Cobb角差异无显著性意义。前路颈椎间盘切除植骨融合组患者术后1周内和术后5年随访时手术椎节高度均显著高于术前；而前路颈椎椎体次全切除植骨融合组患者手术椎节高度仅在术后1周内大于术前。术后1周内和术后5年时，前路颈椎间盘切除植骨融合组患者手术椎节高度大于前路颈椎椎体次全切除植骨融合组。2组植入物沉降率接近，且均未见植入物松动移位。所有患者在术后5年时均获得骨性融合。结果说明采用前路颈椎间盘切除植骨融合和前路颈椎椎体次全切除植骨融合治疗连续双椎节脊髓型颈椎病患者均可取得优良的临床疗效，且前路颈椎间盘切除植骨融合在恢复手术椎节高度方面优于前路颈椎椎体次全切除植骨融合。
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0001-6416-247X(Shen Qiang)
中图分类号:
引用本文
沈 强，丁 浩，朱宗昊，朱 亮，魏小康，贺旭峰. 前路颈椎间盘切除和椎体次全切除植骨融合治疗临近两椎节脊髓型颈椎病[J]. 中国组织工程研究, 2016, 20(48): 7175-7184.
Shen Qiang, Ding Hao, Zhu Zong-hao, Zhu Liang, Wei Xiao-kang, He Xu-feng. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for treating two-level contiguous cervical spondylotic myelopathy[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(48): 7175-7184.
Quantitative analysis of participants
The demographic data, including age, sex, smoking status, body mass index, ASA classification scores, surgery level in each group and follow-up period were summarized in Table 2.
Clinical outcome
Typical cases
Case two: This patient, male, aged 44 years, was diagnosed as CSM at C5-7 that underwent cervical corpectomy and fusion at C5-7 with titanium mesh and plate and screw fixation (Figure 4).
The follow-up period of the patients ranged from 62 to 98 months (average 83.6). Of the original 80 patients, 11 (14%) withdrew from the study, and 7 were lost to follow-up (4 in ACDF group; 3 in ACCF group). Two of the patients in ACDF group withdrew from the study because of a cervical spine injury during follow-up, and another withdrew because of a lumbar disc disease operation during follow-up. In addition, one patient in the ACCF group withdrew because of lumbar disc herniation during follow-up. Of the remaining 69 patients (86%), 33 were in the ACDF group, and 36 were in the ACCF group. ACDF group comprised 15 men and 18 women with a mean age of 52.3 years (range: 37–67 years), whereas ACCF group comprised 23 men and 13 women with a mean age of 55.8 years (range: 25-71 years). The surgery levels involved were C3-5 in 10 cases, C4-6 in 36 cases, and C5-7 in 23 cases. Study flow chart is shown in Figure 2.
The demographic data, including age, sex, smoking status, body mass index, ASA classification scores, surgery level in each group and follow-up period were summarized in Table 2.
Clinical outcome
The JOA scores significantly increased in the ACDF group and ACCF group (P < 0.01). The corresponding VAS scores significantly decreased in the ACDF group and ACCF group (P < 0.01). According to Odom’s criteria, the percentage of patients with excellent and good clinical outcomes was 85% in the ACDF group and 81% in the ACCF group. Although significant JOA scores and VAS scores improvement have been achieved in each group at the final follow-up, there were no significant differences between groups (P > 0.05; Table 3).
Radiological analysis results
The mean operated segmental Cobb angles at pre-, post-operation and 5-year follow-ups were 6.54, 16.65, and 10.48 degrees for ACDF group and 6.63, 10.83, and 9.88 degrees for ACCF group, respectively. There were significant differences in operated segmental Cobb angel between pre-operation and post-operation or 5-year follow-up in each group (P < 0.05). There was no significant difference in the operated segmental Cobb angle between these two groups at 5-year follow-up. The mean C2-7 Cobb angles at pre-, post-operation and 5-year follow-ups were 18.67, 20, and 21.96 degrees for ACDF group and 20.67, 17.63, and 19.88 degrees for ACCF group, respectively. There were no significant differences in C2-7 Cobb angel between pre-operation and post-operation or 5-year follow-up in each group. There was no significant difference in C2-7 Cobb angle between these two groups (Table 4).
In the ACDF group, both post-operative and 5-year follow-up segmental height was significantly larger than pre-operative segmental height (P < 0.05); in the ACCF group, only post-operative segmental height was significantly larger than pre-operative segmental height (P < 0.05), not 5-year follow-up segmental height. At both post-operation and 5-year follow-up, segmental height of the ACDF group was significantly larger than that of ACCF group (P < 0.05). The loss of correction of segmental height in the ACDF group was significantly larger than that in the ACCF group at 5-year follow-up (P < 0.05; Table 4).
The subsidence rates were 31% and 13% in the ACDF group and ACCF group, respectively. There was no significant difference between them.
Solid fusion and bone union in the operated segments were observed in all patients at 5-year follow-up. No patient presented with instrumentation displacement.
Typical cases
Case one: This patient, male, aged 62 years, was diagnosed as CSM at C4-6 that underwent cervical discectomy and fusion at C4-5 and C5-6 with stand-alone cages (Figure 3).
Case two: This patient, male, aged 44 years, was diagnosed as CSM at C5-7 that underwent cervical corpectomy and fusion at C5-7 with titanium mesh and plate and screw fixation (Figure 4).
Adverse reactions
There were some complications after the surgical treatment (Table 2). These complications were completely recovered within two months of after surgery.
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Cervical spondylotic myelopathy (CSM) is a degenerative disc disease that causes spinal cord compression and dysfunction. Patients with symptomatic cervical myelopathy should be considered surgical treatment if conservative treatment is ineffective[1]. Anterior cervical discectomies and interbody cage fusion with or without plate fixation has been proven to be a safe and effective procedure for 1- to 2-level CSM[2-4]. Anterior cervical corpectomy and reconstruction and fusion using plate and titanium mesh may be considered for patients with developmental stenosis and the larger posterior osteophyte or a free disc fragment that has migrated posterior to the vertebral body. When CSM does not include the above corpectomy criteria, controversy exists regarding which is the optimal anterior technique in the treatment of 2-level contiguous CSM[4-6].
To compare the differences in the surgical treatment of two-level CSM between discectomy with stand-alone cage technique and corpectomy with plate-mesh technique, we prospectively observed the clinical and radiological results of the patients with 2-level CSM who had treated with one of these techniques based on a minimum 5-year follow-up.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
Design
This is a prospective, randomized, contrastive clinical study.
Time and setting
This study was conducted at the Shanghai First People’s Hospital Affiliated to Shanghai Jiao Tong University in China between December 2006 and December 2009.
Subjects
A total of 80 patients with a consecutive sequence of hospitalization were randomized in a 1:1 ratio to a anterior cervical discectomy and fusion group (ACDF group) and a anterior cervical corpectomy and fusion group (ACCF group) using the envelope method[7].
The inclusion criteria were (1) cervical myelopathy with no response to 6 weeks of conservative treatment and (2) cervical spine radiography, CT, and/or MRI showing two-level contiguous intervertebral disc herniation and/or posterior border osteophyte of vertebral body.
The exclusion criteria were single-level or more than two-level CSM, two-level CSM without continuity, and CSM with congenital deformity, previous cervical injury and/or cervical surgery, and ossification of the posterior longitudinal ligament.
All patients provided informed consent before surgery. The study was approved by the Ethics Committee of Shanghai First People’s Hospital.
Materials
A total of 66 cages, including Bengal (19 patients), Depuy Synthes Spine, Raynham, MA, USA; Stryker Solis (7 patients), Stryker Australia Pty. Ltd., St. Leonards, NSW, Australia; AO Syncage (7 patients), Synthes Spine, West Chester, PA, USA, were used in ACDF group.
A total of 36 plate-meshes, including Codman® (4 patients), Codman & Shurtleff, Inc., Raynham, MA, USA; Slim-Loc™ (3 patients), DepuySynthes Spine; Skyline® (9 patients), DepuySynthes Spine; Orion™ (4 patients), Medtronic, Inc., Minneapolis, MN, USA; Zephir™ (9 patients), Medtronic, Inc.; CSLP-VA (3 patients), Synthes GmbH, Oberdorf, Switzerland; Reflex® Hybrid (4 patients), Stryker Spine, Mahwah, NJ, USA, were used in ACCF group.
Methods
Operation
The preoperative American Society of Anesthesiologists (ASA) classification scores of all patients were less than 3. Patients received general anesthetic via tracheal intubation. The patient was supine on operating table and neck was supported with sandbag in neutral position. Anterior approach through the transverse incision along the skin crease was made to expose the anterior surface of vertebrae through the space between the carotid sheath and the trachea and esophagus. Disc level was identified using a needle mark inserted into the disc space and was confirmed by intraoperative fluoroscopy.
For patients in the ACDF group, after an interbody pin distractor system was used above and below the discectomy site, a transverse incision through the anterior longitudinal ligament was made at the middle of the disc space. The disc tissue and endplate cartilage were cut and removed using curette. After flushing the space with cold saline, an expanding decompression was made using the different angle smaller diameter curettes to remove the osteophytes on the posterior lips of the vertebrae, then used 1-mm laminectomy punch to cut the posterior longitudinal ligament at the disc space. The dura matter was inspected and no compression of dura matter was assured. After re-flushing the decompressed space with cold saline, small-size gelfoam was inserted into the deep part of the disc space. After appropriate-size cages were selected to fit the interbody space defect. The cages were packed with local decompression bone harvested from the decompression of the posterior border of vertebral body and were then inserted into corresponding interbody space defect under further 1-mm more traction. Proper hardware placement was confirmed by intraoperative fluoroscopy.
For patients in the ACCF group, an interbody pin distractor system was used above and below the corpectomy site. After incised the anterior longitudinal ligament and disc tissue and endplate cartilage at affected disc space, the corresponding interspace vertebral body was excised using a rongeur and different angle smaller diameter curettes. The corresponding posterior longitudinal ligament was incised used 1.0-2.0 mm laminectomy punch. The dura matter was inspected and no compression of dura matter was assured. After flushing the space with cold saline, proper size gelfoam was carefully placed on the dura matter. An appropriate titanium mesh was selected and cut down to fit the corpectomy defect. The mesh was packed with local vertebra bone harvested from decompression and was then inserted into the corpectomy defect under further 1 mm traction. Finally, an anterior cervical titanium plate and screws were applied to achieve anterior cervical fixation. Proper hardware placement was confirmed by intraoperative fluoroscopy.
After operation for both groups, the patients were placed in a soft collar for 6 weeks and encouraged to resume their normal activities.
Clinical evaluation
All data were collected and reviewed by an independent spine surgeon (LZ) using a standardized data-collection form. The neurological function improvement was assessed by the Japanese Orthopaedic Association (JOA) score, which was recorded before surgery and at 5-year follow-up. A full JOA score was defined as 17 points, 8 for upper and lower motor function, 6 for sensory functions, and 3 for bladder rectal function[3]. Neck and radicular pain was evaluated using the Visual Analogue Scale (VAS) before surgery and at 5-year follow-up. Clinical outcome was assessed according to the Odom criteria as shown in Table 1.
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Radiological evaluation
The cervical lordoses were indicated by the methods of Cobb angle of C2-7 and operated segments. The C2-7 Cobb angle was the angle between the inferior endplate line of C2 and inferior endplate line of C7 in a neutral position. The segmental Cobb angle was the angle between the superior endplate line of the cephalad vertebral body and the inferior endplate line of caudal vertebral body of the operated segments in a neutral position. Lordosis is shown as a positive value and kyphosis is shown as a negative value (Figure 1). The Segmental height was measured using the method of Oh et al. [6] and defined as the distance between the midlines of involvedcranial vertebral bodies and caudal vertebral bodies (Figure 1). Instrument subsidence was recorded when the loss of segmental height correction was over 3 mm. Fusion was considered according to the following accepted criteria: (1) absence of motion between the spinous processes at dynamic lateral radiographs, (2) presence of continuous bridging bony trabeculae at the graft-endplate interface[8].
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Main outcome measures
There were (1) perioperative parameters, including patients’ age, sex, smoking condition, body mass index, ASA classification scores, and surgery levels; (2) clinical evaluations included JOA score and VAS score before and at 5-year follow-up after surgery. The Odom score, fusion rate, and complications at 5-year follow-up after surgery. (3) Radiological
evaluations included the segmental and C2-7 Cobb angles, segmental heights, the instrument subsidence rates, and the instrument dislocations before and at 5-year follow-up after surgery.
evaluations included the segmental and C2-7 Cobb angles, segmental heights, the instrument subsidence rates, and the instrument dislocations before and at 5-year follow-up after surgery.
Statistical analysis
Between-group comparisons of the continuous variables were performed using the two-sample F-test for variances, followed by unpaired t-tests. Between-group comparisons of the categorical variables were performed using the chi-square test or Fisher’s exact test. The analysis of Cobb’s angles and segmental heights between groups at each corresponding time point used t-test (two-sample assuming equal variances or unequal variances according its F-test two-sample for variances). The analysis of Cobb’s angles and segmental heights within group at each corresponding time point used t-test (paired two-sample for means).The statistical tests were completed by the SPSS 17.0 software (SPSS Inc, Chicago, IL, USA). In all tests, the difference was considered to be statistically significant at the P values less than 0.05 level.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
The pathophysiology of CSM determines that the relief of the anterior compression of the spinal cord or nerve root is the most direct treatment of CSM[9]. In this study, anterior cervical discectomy or corpectomy operations were performed according to the methods previously described[10-11]. For patients from both groups, we confirmed effective compression by incised the posterior longitudinal ligament and exposed corresponding dura matter used 1-2 mm laminectomy punch during operation. After decompression, the operated segments should be stabilized early by fixation and later by bone fusion[12-15]. The intervertebral height and cervical lordosis should be restored to maintain cervical spine biomechanical requirements[1]. In this study, all patient used autograft harvested from decompression bone cutting. For the maximum restoration of intervertebral height, after decompression and before cage or mesh insertion, we further distracted the interbody pin distractor system 1 mm more, so for ACDF group, 2 mm more distraction and ACCF group, 1 mm more. ACDF group was stabilized through tension-band mechanism and ACCF group added titanium plate and screw fixation early post-operatively.
The use of stand-alone cage technique in cervical spondylosis was first introduced by Bagby [16]. Stand-alone cages have been widely applied in 1- or 2-level pathologies of cervical spondylosis[17-22]. Cho et al. [18] evaluated treatment of multilevel cervical stand-alone cage fusion without plating and autogenous iliac crest graft with plating in 180 consecutive cases of multilevel cervical degenerative disease. They found that both methods were good for interbody fusion in multilevel cervical degenerative diseases, but stand-alone cage fusion was preferred, because it has the fewest complication rates and the least amount of blood loss. Chen et al. [3] compared stand-alone titanium and polyetheretherketon cage in the surgical treatment of multilevel spondylotic myelopathy with over 7-year follow-up and found both groups had good clinical outcome, but polyetheretherketon cage was superior to titanium cage in maintenance of intervertebral height and cervical lordosis. Jang et al [4] reported anterior cervical reconstruction using titanium mesh and plate in patients with cervical degenerative disease. Their result provided good clinical and radiologic outcomes, but the titanium mesh subsidence occurred frequently, especially at the posterior part of the mesh. They concluded that despite the prominent posterior subsidence of the mesh, segmental angle and cervical sagittal angle were improved on final follow-up radiographs, suggesting that posterior subsidence may contribute to cervical lordosis. In this study, we also found that both groups had good cervical lordosis. There was no instrument displacement post-operation and all patients acquired bone fusion at 5-year follow-up.
Many contrastive studies have reported similarly good clinical outcomes for ACCF and ACDF[5-6, 23-24]. Recent meta-analysis combining the results of 15 non-randomized controlled clinical studies reported equivalent outcomes in terms of Odom’s criteria and JOA, VAS, and neck disability index scores in the two treatment groups[25]. In the present study, we compared stand-alone cages ACDF technique and plate and mesh ACCF technique in the treatment of CSM patients. For clinical symptoms and function, both groups had significant improved as indicated by JOA scores and VAS scores and there were no significant differences between these two groups. According to Odom’s criteria, the percentages of patients with excellent and good clinical outcomes were 85% in the ACDF group and 81% in the ACCF group. This study supported that for the two-level contiguous CSM patients, ACDF with stand-alone cages technique and ACCF with plate-mesh technique can provide equivalent effects of spinal cord and nerve roots decompression.
Park et al. [24] reported no significant differences in sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification between single-level ACCF and two-level ACDF with fibula strut allograft and variable-angle screw-plate fixation. Cage subsidence is considered the greatest problem with stand-alone cage technology, with titanium cage subsidence observed in 13%-45 % of cases in two large series[26-27]. Oh et al.[6] reported that the ACCF group was associated with more vertebral body height loss and a reduced lordotic curvature than the ACDF group and believed that a decrease in cervical lordosis may explain the poor improvement in neck pain achieved following ACCF. Therefore, because of using different graft and fixation techniques within ACCF or ACDF, there existed differences about sagittal alignment, cervical lordosis, and graft collapse. According to author’s review, no contrastive study about stand-alone cage ACDF technique and plate-mesh ACCF technique have been reported. In the present study, we found that stand-alone cages ACDF technique significantly increase total segmental height than plate and mesh ACCF technique in 5-year follow-up, although the loss of correction of segmental height in stand-alone cages group was significantly larger than that in plate and mesh group. In stand-alone cages group, both post-operation and 5-year follow-up segmental height were significant larger than pre-operative segmental height; in plate and mesh group, only post-operative segmental height was significantly larger than pre-operative segmental height, not 5-year follow-up segmental height. This made for restoration of intervertebral height, especially when patients associated with congenital spinal canal narrow to obtain indirect decompression by stretching the inward ligament flava is possible. In the present study, no significant differences in the operated segmental and C2-7 Cobb angles were detected between these two groups. In both groups, post-operative and 5-year follow-up operated segmental Cobb angles were significantly better than pre-operative ones.
Flynn[28] reported 311 neurologic complications following 82 114 anterior cervical discectomy and fusion procedures done by 704 neurosurgeons. The rate of temporary recurrent laryngeal nerve paralysis has been reported in 1.69% to 11% of patients following an anterior cervical approach[29-30]. Dysphagia incidences of 50.2%, 32.2%, 17.8%, and 12.5% were found at 1, 2, 6, and 12 months, respectively, after anterior surgery. The risk of dysphagiais higher after multilevel procedures and in patients with longstanding neck pain, and female gender, but the type of procedure (discectomy or corpectomy) and the use of an anterior plate do not influence the prevalence of postoperative dysphagia[31-32]. In this study, the complication rates were 9% and 14% in ACDF group and ACCF group, respectively. One patient in ACCF group had acute radicular pain immediately after operation and the symptom relieved within one month after operation. Three patients had dysphagia which improved 2 months after operation. One patient had temporary hoarseness after operation in the ACCF group. One patient affected cerebrospinal fluid leakage after operation, which was recovered within one week.
Hilibrand et al.[33] reported 93% solid arthrodesis rate with strut grafting, as compared with 66% solid arthrodesis with multiple interbody grafting, both without fixation. Recently, with the use of internal fixation, several reports have concluded that ACDF is not inferior to ACCF in terms of fusion. Wang et al.[34] reported that fusion rates, complication rates, and clinical outcomes were not significantly different between corpectomy and 2-level discectomy with autograft fusion and plate fixation. In the present study, we found that fusion rates, complication rates, and clinical outcomes were not significantly different between corpectomy and 2-level discectomy with autograft fusion by using plate-mesh fixation or stand-alone cages fixation.
In surgical treatment of two-level CSM, ACDF with stand-alone cages technique result in same clinical outcome as ACCF with plate-mash technique according to JOA score, VAS score, Odom’s criteria, fusion rates, and complications, and restoration of operated segmental and cervical lordosis, but ACDF with stand-alone cages technique group exhibited better restoration of intervertebral height than that of the ACCF with plate-mesh technique group in 5-years follow-up. This made for restoration of intervertebral height, especially when patients associated with congenital spinal canal narrow to obtain indirect decompression by stretching the inward ligament flava is possible.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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文题释义：
前路颈椎间盘切除植骨融合：是指自颈部前方经过颈前内脏鞘与血管鞘间隙显露颈椎前方，在两侧颈长肌之间，切除病变椎间隙的前纵韧带，纤维环，髓核，及软骨终板，并切除突入椎管的髓核和椎体后缘增生压迫脊髓的骨赘，达到脊髓前方减压后，该椎间隙植骨融合的手术方式。
前路颈椎椎体次全切除植骨融合：是指自颈部前方经过颈前内脏鞘与血管鞘间隙显露颈椎前方，在两侧颈长肌之间，切除相邻的病变椎间隙以及中间的部分椎体，并切除突入椎管的髓核和椎体后缘增生压迫脊髓的骨赘，达到脊髓前方减压后，该椎间隙和椎体的开槽区域内植骨融合的手术方式。
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
前路颈椎间盘切除植骨融合是指自颈部前方经过颈前内脏鞘与血管鞘间隙显露颈椎前方，在两侧颈长肌之间，切除病变椎间隙的前纵韧带，纤维环，髓核，及软骨终板，并切除突入椎管的髓核和椎体后缘增生压迫脊髓的骨赘，达到脊髓前方减压后，该椎间隙植骨融合的手术方式。 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
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