J Korean Orthop Assoc.  2014 Apr;49(2):147-152. 10.4055/jkoa.2014.49.2.147.

Usefulness of Anterior Cervical Interbody Fusion Using Locally Harvested Bone: Locally Harvested Bone Versus Autogenous Iliac Bone

• Shim DM
• Kim TK
• Oh SK
• Kim SY
• Lee SB

• KMID: 2185220
• DOI: http://doi.org/10.4055/jkoa.2014.49.2.147

Abstract

PURPOSE
The purpose of this study is to evaluate the usefulness of locally harvested bone in anterior cervical interbody fusion.
MATERIALS AND METHODS
A retrospective review was conducted, including 31 patients who underwent anterior cervical interbody fusion using a polyetheretherketone (PEEK) cage and anterior plate fixation. We randomly divided the patients into two groups, local bone group and iliac bone group. In 15 patients of the local bone group, the cage was filled with locally harvested bone, and in another 16 patients of the iliac bone group, the cage was filled with autogenous iliac bone.
RESULTS
Improvements in mean visual analogue scale (VAS) scores, from 5.8 and 7.7 to 1.6 and 2.3 for neck pain and arm pain, respectively, were observed in cases using locally harvested bone, while the improvements were from 5.7 and 7.2 to 1.4 and 2.2, respectively, in those using autogenous iliac bone grafts. However, no significant differences in mean VAS and neck disability index were observed between the two groups at the last follow up (p>0.05). Radiologic union was achieved at 14.0+/-2.50 weeks in the local bone group, and at 12.62+/-1.58 weeks in the iliac bone group. However, no significant difference was observed between the two groups (p=0.076).
CONCLUSION
Utilization of locally harvested bone for packing in a PEEK cage for anterior cervical interbody fusion is considered a useful method because it gives satisfactory clinical results for retention of bone union and lordosis angles.

Keyword

cervical spine; anterior cervical spinal fusion; PEEK cage; locally harvested autobone; autogeneous iliac bone graft

MeSH Terms

Animals
Arm
Follow-Up Studies
Humans
Lordosis
Neck
Neck Pain
Retrospective Studies
Transplants

Figure

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  Figure 1 Polyetheretherketone cages packed with locally harvested bone.

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  Figure 2 Postoperative lateral image of anterior discectomy and fusion with locally harvested bone.

Reference

1. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958; 40:607–624.

2. Whitecloud TS 3rd. Complications of anterior cervical fusion. American Academy of Orthopaedic Surgeons. Instructional Course Lectures. St. Louis: CV Mosby;1978. Vol. 27:p. 223–227.

3. Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma. 1989; 3:192–195.

4. Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine (Phila Pa 1976). 1993; 18:2106–2107.

5. Yang JJ, Yu CH, Chang BS, Yeom JS, Lee JH, Lee CK. Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage. Clin Orthop Surg. 2011; 3:16–23.

6. Song KJ, Lee KB, Kim KB. Comparison according to fusion level in ACDF Using PEEK cage alone for degenerative cervical disease. J Korean Orthop Assoc. 2011; 46:364–371.

7. Savolainen S, Rinne J, Hernesniemi J. A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery. 1998; 43:51–55.

8. Geer CP, Papadopoulos SM. The argument for single-level anterior cervical discectomy and fusion with anterior plate fixation. Clin Neurosurg. 1999; 45:25–29.

9. Caspar W, Barbier DD, Klara PM. Anterior cervical fusion and Caspar plate stabilization for cervical trauma. Neurosurgery. 1989; 25:491–502.

10. Zeidman SM, Ducker TB, Raycroft J. Trends and complications in cervical spine surgery: 1989-1993. J Spinal Disord. 1997; 10:523–526.

11. Schils F, Rilliet B, Payer M. Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study. J Neurosurg Spine. 2006; 4:292–299.

12. Thomé C, Krauss JK, Zevgaridis D. A prospective clinical comparison of rectangular titanium cages and iliac crest autografts in anterior cervical discectomy and fusion. Neurosurg Rev. 2004; 27:34–41.

13. Park HJ, Kim WK, Ryu HY. Efficiency of anterior interbody fusion using cage and plate in the distractive flexion injury of cervical spine: cage vs tricortical autoiliac bone. J Korean Soc Spine Surg. 2009; 16:71–78.

14. Choi BW, Song KJ. Current concept on the surgical treatment by anterior approach in degenerative cervical radiculopathy. J Korean Soc Spine Surg. 2011; 18:34–41.

15. Liao JC, Niu CC, Chen WJ, Chen LH. Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop. 2008; 32:643–648.

16. Salame K, Ouaknine GE, Razon N, Rochkind S. The use of carbon fiber cages in anterior cervical interbody fusion: report of 100 cases. Neurosurg Focus. 2002; 12:E1.