ハイドロキシアパタイト製スクリュー (K-CHAS^<TM>) による頚椎前方固定術

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  • Anterior Cervical Fusion with the Kosuke-Cervical Hydroxyapatite Screw (K-CHAS^<TM>)

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Recently, the use of hydroxyapatite as a substitute for an iliac bone graft in anterior cervical fusion has been reported, but is associated with some problems, such as a slip out of the hydroxyapatite plugs or the development of a radiolucent zone around the implant on postoperative X-rays. While porous hydroxyapatite promotes bony ingrowth, a significant number of implant collapses have been reported. To avoid these complications, anterior titanium plates or cages are used. Patients treated with an anterior plate, however, run the risk of not only hardware complications but also a decreased fusion rate for single-level fusion. On the other hand, the use of the titanium cages occasionally leads to vertebral body collapse. Moreover, cages cause an artifact on magnetic resonance T2-weighted axial imaging. We have developed a new implant in order to avoid all those drawbacks and complications. The device, which we call the K-CHAS, is made of dense hydroxyapatite and β-tricalcium phosphate (β-TCP) composite, is 11mm in length, 8mm in anterior diameter and 7mm in posterior diameter, and is threaded. The K-CHAS can withstand a compression force of 501kg/cm^2. β-TCP actively promotes osteogenesis and can be eventually replaced by bone. The Smith-Robinson's procedure is indicated, in which two implants are screwed into the intervertebral space in parallel. There is no need to harvest or collect bone. We have used this implant at 42 levels in 37 patients, with mean age of 55.4 years. Patients were placed in a hard cervical collar for 1 to 2 weeks after operation. They were allowed to walk on the second postoperative day. There were no intraoperative complications. Radiological follow-up showed neither instability nor any radiolucent zones. The K-CHAS provides immediate, solid stability of the cervical spine and brings about early fusion in the anterior cervical spine surgery.

収録刊行物

  • 脊髄外科

    脊髄外科 16 (2), 119-126, 2002

    日本脊髄外科学会

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