Interspace Distraction and Graft Subsidence After Anterior Lumbar Fusion With Femoral Strut Allograft

Kumar, Amit; Kozák, J; Doherty, Brian J.; Dickson, Jesse H.

doi:10.1097/00007632-199312000-00005

Cited by 126 publications

(65 citation statements)

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“…Both reports of cervical cage trials [4,16] deal with preliminary results; long-term results have not yet been reported. However, experience suggests long-term complications in the use of cervical cages, such as subsidence of the cages into the adjacent vertebrae or bone resorption within the cages [7,10,12,15]. Bone resorption and substitution by soft tissue may be caused by insufficient stability [21] or by inadequate loading of the bone within the cages.…”

Section: Discussionmentioning

confidence: 99%

Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement

Wilke¹,

Kettler²,

Claes³

2000

European Spine Journal

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Section: Discussionmentioning

confidence: 99%

Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement

Wilke¹,

Kettler²,

Claes³

2000

European Spine Journal

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“…3,5,11 Stand-alone implants are susceptible to subsidence into the vertebral endplates. Subsidence of the implants, which occurs over the course of several years postoperatively, often leads to segmental spinal instability, loss of lordosis, angular frontal-plane deformities, and sagittal-plane translation.…”

Section: Spinal Alignmentmentioning

confidence: 99%

Surgical Interbody Research Group–radiographic assessment of interbody fusion devices: fusion criteria for anterior lumbar interbody surgery

Burkus¹,

Foley²,

Haid³

et al. 2001

FOC

119

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The authors present their radiographic criteria for assessing fusion of the lumbar spine after anterior interbody fusion with intradiscal implants. These criteria include the assessment of plain radiographs, dynamic motion radiographs, and thin-cut computerized tomography scans. Fusion within the instrumented spinal motion segment can be determined using radiographic evaluation to assess spinal alignment on sequential examinations, angular and translational changes on dynamic motion studies, and device–host interface, and to identify new bone formation and bone remodeling. Finally, to aid the clinician in assessing fusion, the authors describe the five zones of fusion within the intervertebral disc space.

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“…This must then be considered a more desirable technique of union assessment. Moreover, several authors have suggested that the ability of plain radiographic examination to demonstrate trabecular structure is limited [12,13,21,24]. This is probably due to the inability of plain radiographs to assess intricate three-dimensional structure and to detect subtle differences in tissue density.…”

Section: Grade II (Partial Fusion)mentioning

confidence: 99%

“…Sarwat et al [21] noted that dynamic views are of limited value in providing information on spinal stability at least in the period up to 6 months following surgery due to patients' experience of postoperative muscular pain at the terminal limits of spinal flexion and extension. Kumar et al [13] retrospectively reviewed 32 patients who underwent single level anterior fusion with femoral ring allografts with a mean follow-up of 36 months. Radiographic union was identified in 66% of patients on static films, however if flexion/extension radiographs were taken into account (functional arthrodesis), an additional 22% of patients were considered to have had a successful fusion.…”

Section: Grade II (Partial Fusion)mentioning

confidence: 99%

CT-based classification of long spinal allograft fusion

et al. 2007

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Anterior column reconstruction of the thoracolumbar spine by structural allograft has an increased potential for biological fusion when compared to synthetic reconstructive options. Estimation of cortical union and trabecular in-growth is, however, traditionally based on plain radiography, a technique lacking in sensitivity. A new assessment method of bony union using high-speed spiral CT imaging is proposed which reflects the gradually increasing biological stability of the construct. Grade I (complete fusion) implies cortical union of the allograft and central trabecular continuity. Grade II (partial fusion) implies cortical union of the structural allograft with partial trabecular incorporation. Grade III (unipolar pseudarthrosis) denotes superior or inferior cortical non-union of the central allograft with partial trabecular discontinuity centrally and Grade IV (bipolar pseudarthrosis) suggests both superior and inferior cortical non-union with a complete lack of central trabecular continuity. Twenty-five patients underwent anterior spinal reconstruction for a single level burst fracture between T4 and L5. At a minimum of two years follow up the subjects underwent high-speed spiral CT scanning through the reconstructed region of the thoracolumbar spine. The classification showed satisfactory interobserver (kappa score = 0.91) and intraobserver (kappa score = 0.95) reliability. The use of high-speed CT imaging in the assessment of structural allograft union may allow a more accurate assessment of union. The classification system presented allows a reproducible categorization of allograft incorporation with implications for treatment.

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Interspace Distraction and Graft Subsidence After Anterior Lumbar Fusion With Femoral Strut Allograft

Cited by 126 publications

References 0 publications

Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement

Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement

Surgical Interbody Research Group–radiographic assessment of interbody fusion devices: fusion criteria for anterior lumbar interbody surgery

CT-based classification of long spinal allograft fusion

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