Effect Of Two Kinds Of Internal Fixation Devices And Platelet Rich Plasma On Improving Fusion Rate After Cervical Spine Surgery

BackgroundHerniation of cervical disc is one of clinical common disease,mainly is refers to the intervertebral disc（consist of nucleus pulposus,fiber ring and the cartilage plate）,especially the nucleus pulposus,after the degenerative change,under the action of external force factors,highlight the rear（or emergence）in the spinal canal and cause of spinal cord and spinal nerve root compression or stimulated,because of the mechanical nerve compression and local inflammatory stimulation and appear a series of corresponding neurological symptoms.In China,with the popularity of electronic devices such as computers and smart phones,as well as changes in work and lifestyle,the incidence of cervical disc herniation is increasing day by day.Now the overall incidence is 3.8%-17.6%,males are higher than females,most of which occur in40-50 years old,and C4/5 and C5/6 are the most prominent parts of cervical disc herniation.Anterior cervical decompression and fusion（ACDF）is a classic surgical method for the surgical treatment of cervical disc herniation[1].The purpose of cervical fusion is to relieve nerve compression through nerve decompression and to achieve long-term stability through strong intervertebral fusion.Excellent anterior cervical decompression and fusion results can achieve both goals.In the past,in order to improve the fusion rate of bone grafting,autogenous iliac bone grafts were performed clinically.However,there were some problems,such as limited bone volume in autogenous donor site and relatively high complication rate in donor site.With the increasingly mature techniques of clinicians and the progress of plant techniques in various orthopedic departments,interbody fusion cages have replaced autogenous iliac bone as the main method of vertebral interbody fusion,but problems such as loosening,displacement,sinking,and low fusion rate of interbody fusion have followed[2,3].Therefore,the selection of appropriate cervical anterior internal fixation devices and bone grafting materials to improve the fusion rate of bone grafting has become the forefront of clinical focus at home and abroad.ObjectiveThe imaging results and clinical therapeutic effect of ACDF after using two kinds of internal fixation devices and combined with platelet-rich plasma bone grafting were analyzed,and the influence of different methods on the fusion rate of bone grafting was evaluated and the clinical application was guided by the above results.MethodsA retrospective study was conducted on 387 patients who underwent cervical spine surgery from two different institutions（Shanghai First People’s Hospital and Nanjing Jiangbei People’s Hospital）between October 2018 and March2020.According to internal fixation device and its application in patients with bone graft materials of different divided into four groups:a.traditional nail plate group:anterior cervical titanium plate fixation plate piece+intervertebral fusion（filling the allogeneic bone）B.Zero-p group:zero incisura anterior cervical intervertebral fusion（filling the allogeneic bone）c.ROI-C^TM:anterior cervical fixation bridge insert device（filling the allogeneic bone）d.ROI-C^TM+PRP:anterior cervical fixation bridge insert device（filling and platelet rich plasma mixture of allogeneic bone）.VAS score and JOA score were observed and recorded continuously 1 year after surgery,and cervical anteroposterional and lateral X-ray were reexamined for diagnosis of interbody fusion,and the influence of four different methods on the fusion rate of bone graft was evaluated.ResultsA total of 121 of the 387 patients completed follow-up,including 28 in the traditional nail plate group,35 in the Zero-p group,27 in the ROI-C^TM group,and 31in the ROI-C^TM+PRP group.There was no difference in preoperative basal scores among the four groups.In the early stage of postoperative rehabilitation（3 days after surgery）,the VAS and JOA scores of patients in the four groups were significantly improved compared with those before surgery,and there was no significant difference in the improvement of VAS and JOA scores and the bone graft fusion rate in the four groups.However,after 6 weeks of rehabilitation,the improvement of VAS and JOA scores and the fusion rate of bone grafts in the four groups began to show significant differences.VAS scores in the four groups were 1.536±0.793,1.257±0.611,0.778±0.577 and 0.355±0.486,respectively.JOA scores were 15.643±0.488,15.714±0.667,15.963±0.518 and 16.226±0.617,respectively.In addition,6 weeks after surgery,the bone graft fusion rate of ROI-C^TM+PRP group（64.52%）was significantly better than that of ROI-C^TM group（51.85%）,the bone graft fusion rate of ROI-C^TM group and Zero-p group（51.43%）,but significantly better than that of the traditional screw plate group（39.29%）.ConclusionClinical and radiographic results showed that all patients showed significant improvement after surgical treatment compared with preoperative symptoms.However,as the recovery time,the use of different internal fixation devices and bone graft material of the patients were found at the horizontal comparison,anterior cervical fixation bridge insert device（filling and platelet rich plasma mixture of allogeneic bone）to increase the rate of bone graft fusion and improving the prognosis of patients have obvious advantages,is worth popularization and application in the clinical practice.