Relationship Between Intraoperative Intervertebral Distraction And Titanium Mesh Subsidence After Anterior Cervical Corpectomy And Fusion

Objective:To investigate the effect of intervertebral distraction to titanium mesh cage subsidence after single level anterior cervical corpectomy and fusion(ACCF).Provide reference for clinical work.Methods:We retrospectively analyzed the clinical data of 31 patients underwent single level anterior cervical corpectomy combined with titanium mesh graft fusion from February 2016 to June 2017 in our hospital.Measure the X-ray of the cervical spine token before surgery,1 day after surgery,and 3 months after surgery.According to the decrease of the intervertebral height,the patients were divided into two groups,titanium mesh subsidence group(height loss more than 2mm)and titanium mesh non-subsidence group(height loss less than 2mm).According to the Japanese Orthopaedic Association Scores(JOA),the neurological function before and after surgery was evaluated and the improvement rate of neurological function was compared between the two groups.Analyze and compare whether there is a statistical difference between the two groups of data in the height of intervertebral distraction.The Logistic regression analysis was used to determine whether the height of intervertebral distraction was the cause of titanium mesh subsidence.Determine the critical value of the height of intervertebral distraction through the Youden index.Results:There was 19 patients of subsidence group occured titanium mesh cage subsidence and 12 patients of non-subsidence group not.The rate of postoperative neurological improvement in the titanium mesh subsidence group was 49.44%±20%,and the rate of titanium mesh non-subsidence group was 78.14%±16%,the difference was statistically significant.Titanium mesh subsidence is not conducive to the improvement of neurological function after anterior cervical corpectomy and fusion.The intervertebral distraction height of the titanium mesh subsidence group was 6.99mm±3.29 mm,and in the titanium mesh non-subsidence group was 4.57mm±2.29 mm.The difference was statistically significant.Logostic regression analysis showed that increased intervertebral distraction was a risk factor for postoperative titanium mesh subsidence.According to the Yodner index,its critical value is 6.99 mm.Conclusions:The height of intraoperative intervertebral distraction is a risk factor for postoperative titanium mesh subsidence.For every 1mm increase in intervertebral distention,the probability of subsidence of titanium mesh increases by 1.394 times.The critical value between them is 6.99 mm.Titanium mesh subsidence may lead to poor postoperative neurological recovery.To prevent the occurrence of postoperative titanium mesh subsidence,Intervertebral distraction should be controlled at 4mm-6.99 mm in single level anterior cervical corpectomy and fusion.