Application Of Facet Joint Bone Graft In Posterior Decompression And Fusion Of Lower Cervical Spine

ObjectiveTo evaluate the efficacy of facet joint bone graft in posterior fusion of lower cervical spine,and it can also provide a clinical basis for the futural design of lower cervical facet intra-articular fusion cage,and to lay a theoretical basis and practical reference for the next research.Methods60 patients with multilevel ossification of cervical posterior longitudinal ligament who met the inclusion criteria of this study were randomly selected(from January 2016 to December 2019,391 patients with cervical diseases were treated in this treatment group).All patients underwent posterior single door laminoplasty and lateral mass screw internal fixation,and 30 patients were randomly selected for intraoperative bone grafting on the side of the portal axis and intra articular facet joint grafting on the opposite side The other 30 cases were treated with intraoperative bone grafting on the side of the portal shaft,and the contralateral bone grafting on the surface of the lateral mass,which was called group B.In group A,the articular cartilage of the facet joint was destroyed by a tap screwing in and out the joint space repeatedly,and the prepared autologous cancellous bone particles was implanted into the facet joint space.In group B,the prepared autologous cancellous bone particles were placed on the surface of the lateral mass of open-door side.Successful posterior fusion of the lower cervical spine requires improvement of postoperative symptoms of spinal cord compression,maintenance of long-term outcomes,and the strong bony fusion,radiographic findings of well-defined bridge formation at the grafted site.The operation time,blood loss,bone fusion rate,JOA score and VAS score were compared between group A and group B.At the same time,the JOA score and VAS score of group A and B before and after operation were compared.Statistical software was used,and age,operation time,blood loss,VAS and JOA score(preoperative and postoperative 6 months,1 year)were expressed as mean ± standard deviation.All the data conform to normal distribution,and t test was used.When P<0.05,the difference was statistically significant,when P>0.05,there was no significant difference between the two groups.The fusion was evaluated by imaging,the postoperative review of cervical 3D CT showed whether bone Bridges were formed in the facet joints.ResultsThe symptoms of all patients were significantly improved after operation,and the postoperative complications were as follows: a total of 3 patients developed C5 nerve root paralysis after operation: 1 patient in group a developed C5 nerve root paralysis 3days after operation,and recovered 6 weeks after operation;1 patient in group B developed C5 nerve root paralysis 6 days after operation,and recovered 8 weeks after operation;another patient developed C5 nerve root paralysis 1 week after operation,and recovered 4 weeks after operation.There were 3 patients with poor wound healing after operation: 1 patient in group A had postoperative wound infection and healed well after debridement and suture;1 patient in group B had delayed wound healing and healed well after infrared light therapy,and 1 patient had postoperative wound infection and healed well after debridement and suture.A total of 21 patients with different degrees of postoperative neck and shoulder axial pain: 11 cases in group A,10 cases in group B.According to the fusion standard,the postoperative bone fusion rate was 100%,and there was no postoperative failure of internal fixation.There were no statistically significant differences in operation time,blood loss,JOA score and VAS score between A and B groups(P>0.05).The postoperative nerve recovery of the patients was good,and the JOA score and VAS score at 6 months and 1 year after the operation were significantly different from those before the operation(P<0.05).ConclusionsIn the case of no significant difference in the effect of the two kinds of bone graft methods,compared with the bone graft on the surface of the lateral mass,the intra-articular bone graft of the facet joint has the advantages of easier operation,smaller wound,no risk of bone graft particles entering the spinal canal to compress the cervical spinal cord,less demand for bone graft,high rate of osseous fusion and low rate of pseudarthrosis,so the intra-articular bone graft of the facet joint of the lower cervical spine can replace lateral mass surface grafting as a new method for posterior fusion of lower cervical spine,and it can also provide a clinical basis for the futural design of lower cervical facet intra-articular fusion cage.