Autograft versus Allograft in Degenerative Cervical Disease

Malloy, Kelly M.; Hilibrand, Alan S.

doi:10.1097/00003086-200201000-00004

Cited by 149 publications

(81 citation statements)

References 27 publications

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“…In this study, ASD was also the most common reason for a new intervention in the ACDF group, while intervention for pseudarthrosis was less than 1% which is lower than found in another retrospective study of 672 patients [23], but consistent with other publications [24,25]. A majority of patients in this cohort were treated with iliac crest bone and plating which might create better conditions for healing than alternative methods [26][27][28]. It should also be pointed out that pseudarthrosis could be a difficult diagnosis to establish as there is no sufficiently accurate radiological method to ensure very small movements in non-healed segments [29,30].…”

Section: Discussionsupporting

confidence: 87%

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

2017

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Purpose To evaluate rates of secondary surgical interventions in a cohort treated with fusion (ACDF), artificial disc replacement (ADR) or a posterior surgical procedure (PP) because of a cervical degenerative pathology. Methods 715 patients treated with any primary cervical surgical intervention between the years 2000 and 2010 were retrospectively evaluated regarding frequency of secondary surgery between the years 2000 and 2015, thus giving a follow-up time of minimum 5 years. Reasons for secondary surgery as well as choice of new intervention were evaluated. Data were collected from a single-center setting. Results Follow-up rate was 94%. 79 (11%) patients in total underwent a new operation during follow-up. 50/504 (10%), 27/172 (15%), and 2/39 (5%) of the patients had a second surgical intervention in the ACDF, ADR, and PP groups, respectively. There was a statistically significant higher rate of repeated surgery in the ADR group compared to the ACDF group, OR 1.7 (CI 1.06-2.8), p = 0.03. Risk for repeated surgery at index level was even higher for ADR, OR 5.1 (CI 2.4-10.7), p \ 0.001. Reoperation rate because of ASD in the whole cohort did not differ between ACDF and ADR groups, p = 0.40. ConclusionThe group initially treated with artificial disc replacement showed higher rate of reoperations and more implant-related complications. In this cohort, artificial disc replacement was not protective against reoperation because of adjacent segment pathology.

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Section: Discussionsupporting

confidence: 87%

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

2017

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“…This technique allows direct decompression of neural structures, restoration of disc height, and stabilization of the affected motion segments [2,3]. The success of the procedure relies on the development of a solid arthrodesis, although pseudarthrosis is not always associated with inferior outcome [4,5].…”

Section: Introductionmentioning

confidence: 99%

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

2012

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Introduction Three-or four-level anterior cervical discectomy and fusion with autograft and plate fixation have demonstrated relatively good fusion rates and outcomes, but donor site morbidity and the limitations of autograft harvest remain problematic. The purpose of this study is to assess the radiographic and clinical outcomes of three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct. Methods This retrospective review included 43 consecutive patients who underwent three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct (three level: 39 cases, four level: 4 cases). The fusion rate, time to fusion, Cobb angle and disc height were assessed radiographically. Clinical outcomes were evaluated with the VAS, NDI, and SF36 scores. Complications were also recorded. Results Solid fusion was achieved in all the patients, and mean time to fusion was 13.7 ± 5.1 weeks. The postoperative Cobb angle, lordotic angle, and disc height (5.6°, 10.5°a nd 3.15 mm, respectively) increased significantly compared to preoperative values (p = 0.038, p = 0.032, and p = 0.0004, respectively), and these improvements were maintained through final follow-up. The postoperative NDI (17.2), VAS (2.8), and SF36 (13.1) scores increased significantly compared to the preoperative scores (p = 0.026, p = 0.0007 and p = 0.041, respectively). Complications included three cases of respiratory difficulty, four cases of dysphagia and one case of hoarseness. There were no cases of donor site morbidity. Conclusions Three-or four-level anterior cervical discectomy and fusion with a PEEK cage, and plate construct provide good clinical and radiographic outcomes including high fusion rates, low complication rates, low donor site morbidity, and good maintenance of the lordotic angle and disc height in the treatment of multilevel cervical spondylosis.

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“…Associated donor site morbidity is an additional consideration [15,16]. Patients often have compliance difficulties with cervical bracing when fibula strut grafts are used without plating.…”

Section: Discussionmentioning

confidence: 99%

New Approach to Filling a Corpectomy Defect by Stacking Multiple Peek Cages around a Fibula Strut Graft: A Technical Note

Chin¹

2015

J Spine

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Study background: Fibula strut grafts alone during anterior cervical corpectomies have some inherent vulnerability. In contrast PEEK (Polyetheretherketone) cages are more stable but need separate graft material for interbody fusion. The opportunity therefore exists to combine the positive attributes of a fibula strut graft and a PEEK interbody cage for corpectomy. The authors aim to illustrate the use of stacking multiple PEEK cages around a fibula strut graft for cervical corpectomy. Methods:We present two illustrative cases of the technique of stacking three PEEK cages around a fibula strut graft (group 1). Cases were compared to cohort of 15 patients (group 2) with 3 level anterior cervical discectomy and fusion (ACDF).Results: Average age and BMI for group 1 was 52 years and 36.9 kg/m 2 compared to group 2 average age 59 years and BMI 25 kg/m 2 , p=0.53 and 0.21 respectively. Mean preop VAS neck score in group 1 of 8.5 compared to group 2 of 6.5, p=0.08. Preop NDI in group 1 of 52 compared to group 2 of 43.4, p=0.355. There was no statistical difference in post op outcomes at 6, 12 and 24 months, p>0.05. There was no evidence of construct failure, subsidence, or focal kyphosis in either group which was demonstrated on CT radiograph. Conclusion:We have illustrated technique of combining the strength of a fibula strut graft for achieving fusion and PEEK cages for stability and favourable modulus of elasticity of that the vertebrae. The assessment of outcome scores demonstrated similar efficacy of treatment. There were no reported major complications in either group. Further application of this approach is the next steps to establish this technique's efficacy.

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Autograft versus Allograft in Degenerative Cervical Disease

Cited by 149 publications

References 27 publications

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

New Approach to Filling a Corpectomy Defect by Stacking Multiple Peek Cages around a Fibula Strut Graft: A Technical Note

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