A prospective clinical and radiographic 12-month outcome study of patients undergoing single-level anterior cervical discectomy and fusion for symptomatic cervical degenerative disc disease utilizing a novel viable allogeneic, cancellous, bone matrix (trinity evolution™) with a comparison to historical controls

Vanichkachorn, Jed S.; Peppers, Timothy; Bullard, Dennis E.; Stanley, Scott K.; Linovitz, Raymond; Ryaby, James T.

doi:10.1007/s00586-016-4414-7

Cited by 43 publications

(38 citation statements)

References 24 publications

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“…For the interspinous process method, no motion (9 of 22, 40.9%) [ 13 , 14 , 17 , 21 , 24 , 26 , 29 , 33 , 37 ], under 1 millimeter (mm) (7 of 22, 31.8%) [ 10 , 20 , 28 , 31 , 32 , 41 , 42 ], under 2 mm (2 of 22, 9.1%) [ 12 , 35 ], and under 3 mm of motion (4 of 22, 18.2%) [ 27 , 30 , 40 , 43 ] between spinous process were all used as cutoff values for a definition of fusion. Using the Cobb angle method, changes of 1 degree (1 of 12, 8.3%) [ 38 ], 1.5 degrees (1 of 12, 8.3%) [ 42 ], 2 degrees (5 of 12, 41.7%) [ 19 , 25 , 36 , 44 , 46 ], 4 degrees (4 of 12, 25.0%) [ 11 , 43 , 45 ], and 5 degrees (2 of 12, 16.7%) [ 27 , 30 ] were all used in various studies.…”

Section: Resultsmentioning

confidence: 99%

“…In addition to plain radiographs, CT scans were frequently used (53.8%) [ 10 , 12 , 15 , 16 , 19 , 22 , 26 , 29 , 33 - 38 , 41 , 43 , 45 - 49 ], to assess pseudoarthrosis following ambiguous radiographic findings. The interobserver reliability of predicting pseudoarthrosis is better using the CT scan despite the metal artifacts compared to dynamic cervical spine films [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Lin

Boddapati

et al. 2018

Neurospine

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Radiographic confirmation of fusion after anterior cervical discectomy and fusion (ACDF) surgery is a critical aspect of determining surgical success. However, there is a lack of established diagnostic radiographic parameters for pseudoarthrosis. The purpose of this study is to summarize the findings of previous studies, review the advantages and disadvantages of frequently employed diagnostic criteria, and present our recommended protocol of fusion assessment. This study identified randomized controlled trials, case-control studies, and prospective and retrospective cohort studies reporting on spinal fusion and how successful fusion after ACDF. Among the 39 articles reviewed, bridging bone across the operated levels on static radiographs was the most commonly used criteria to confirm fusion (31 of 39, 79%). Dynamic flexion-extension radiographs were used to assess for interspinous movement (ISM) (22 of 39, 56.4%) and change in Cobb angle (12 of 39, 30.8%). Computed tomography (CT) based findings (21 of 39, 53.8%) were employed in ambiguous cases with improved sensitivity and specificity. Reconstructed CT scans were used to assess for intragraft bridging bone and extragraft bridging bone (ExGBB). ExGBB were proved to have the highest diagnostic sensitivity and specificity for pseudoarthrosis detection when compared to all other radiographic criteria. The ISM <1 mm on dynamic flexion-extension radiographs had high diagnostic sensitivity and specificity as well. After our reviewing, we recommend using dynamic lateral flexion-extension cervical spine radiographs at 150% magnificationin which the interspinous motion <1 mm and superjacent interspinous motion ≥4 mm confirms fusion. In ambiguous cases, we recommend using reconstructed CT scans to evaluate for ExGBB.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Lin

Boddapati

et al. 2018

Neurospine

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“…They generally report fusion rates 90% or greater at the 12 or 24 month point using a combination of plain films and computed tomography scans. A recent multicenter study looking at patients with 12 months of follow-up after undergoing single level ACDF with a commercial CBM product noted an overall fusion rate of 93.5% that persisted even when stratifying for patients with high risk factors (history of smoking, diabetes, obesity/severe obesity) [29]. In our study, patients underwent multilevel fusion and only 5 out of the 21 patients had no medical risk factors for adverse outcomes.…”

Section: Discussionmentioning

confidence: 61%

Use of Allogenic Mesenchymal Cellular Bone Matrix in Anterior and Posterior Cervical Spinal Fusion: A Case Series of 21 Patients

Divi

Mikhael

2017

Asian Spine J

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Study DesignRetrospective case series.PurposeTo report our early experience using allogenic mesenchymal cellular bone matrix (CBM) products in cervical spine fusion.Overview of LiteratureMulti-level cervical fusions have historically yielded lower fusion rates than single level fusions, especially in patients with high risk medical comorbidities. At this time, significant literature in cervical fusion outcomes with this cellular allograft technology is lacking.MethodsTwenty-one patients underwent either multilevel (3 or 4 level) anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, or posterior cervical fusion. ViviGen (DePuy Synthes Spine, Raynham, MA, USA), an allogenic bone matrix product, was used in addition to standard instrumentation. Radiographic evaluation was performed at 2 weeks, 12 weeks, 24 weeks and 1 year postoperative. Visual analog scale (VAS) and neck disability index (NDI) scores along with return to work and leisure activity were recorded.ResultsAt 6 months postoperative, all patients had radiographic evidence of bone fusion regardless of age or medical comorbidities. All patients reported subjective improvement with a mean decrease in VAS from 8.3 to 1.5 and a mean decrease in NDI from 40.3% to 6.0% at 1 year. All patients also returned to work and/or regular leisure activity within 3 months.ConclusionsTwenty-one patients undergoing high-risk anterior and posterior cervical spine fusion, with the use of a commercially available mesenchymal CBM product, went on to radiographic fusion and all had improvement in subjective outcomes. While further effort and research is needed to validate its widespread use, this study shows favorable use of CBM in cervical fusion for high-risk cases.

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“…Studies have shown that low-profile PEEK cages may reduce esophageal damage because its placement is limited to the confinement of the intervertebral disc space. Other types of newer cages, such as hybrid cages that combine PEEK and titanium, need more clinical evidence to fully understand their efficacy and long-term safety [ 27 ].…”

Section: Reviewmentioning

confidence: 99%

Anterior Techniques in Managing Cervical Disc Disease

Kim

D’Souza

et al. 2018

Cureus

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Surgical treatment may be indicated for select patients with cervical disc disease, whether it is cervical disc herniation or spondylosis due to degenerative changes, acute cervical injury due to trauma, or other underlying cervical pathology. Currently, there are various surgical techniques, including anterior, posterior, or combined approaches, in addition to new interventions being utilized in practice. Ideally, the surgical approach should be selected in consideration of each patient’s clinical presentation, imaging findings, and overall medical comorbidities on an individual basis. But the unique advantages and disadvantages of each surgical technique often complicate the therapy choice in managing cervical disc diseases. Although anterior cervical discectomy and fusion (ACDF) is the most widely accepted procedure performed for both single and multi-level cervical disc diseases, there are multiple modifications to this technique. Surgeons have access to different types of plates, screws, and cages and can adopt newer advances in the field such as stand-alone and minimally invasive techniques when indicated. In short, no consensus exists in terms of a single approach that is preferred for all patients. This article aims to review the standard of care for management of cervical disc disease with a focus on the surgical techniques and, in particular, the anterior approach, exploring the various surgical options within this technique.

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Cited by 43 publications

References 24 publications

Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Diagnosing Pseudoarthrosis After Anterior Cervical Discectomy and Fusion

Use of Allogenic Mesenchymal Cellular Bone Matrix in Anterior and Posterior Cervical Spinal Fusion: A Case Series of 21 Patients

Anterior Techniques in Managing Cervical Disc Disease

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