Radiologic Changes of Anterior Cervical Discectomy and Fusion Using Allograft and Plate Augmentation: Comparison of Using Fixed and Variable Type Screw

Oh, Keun Sang; Lee, Chul Kyu; You, Nam Kyu; Kim, Sang Hyun; Cho, Ki Hong

doi:10.14245/kjs.2013.10.3.160

Cited by 14 publications

(13 citation statements)

References 22 publications

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“…Therefore, recent ACDF studies tend to mainly focus on alternative graft materials with comparable outcomes without the problems related to autograft. As anterior plating becomes more popular, an increasing number of articles support allograft using ACDF with plate augmentation, showing improved postoperative clinical and radiological outcomes [6,18,20-23]. When the plate is augmented, fusion rate was reported to be similar or even better than ACDF without plate fixation [18,24].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that treatment using cervical plates significantly reduces graft-related complication rates in one- and two-level ACDF with allograft cortical bone, with significantly enhanced arthrodesis [6,21,25]. In particular, Kaiser et al [21] reported a significant decrease in the graft-related complication rate with anterior plating.…”

Section: Discussionmentioning

confidence: 99%

“…Among these materials, tricortical iliac autograft has provided the best outcomes with excellent fusion rate, lower proportion of delayed union [2], and good clinical results [3,4]. Recent ACDF studies using allograft have reported excellent clinical outcomes compared with those using autograft [5,6]. Previously, the use of allograft resulted in more cases of nonunion, delayed fusion, graft dislodgement or subsidence, and weakness in mechanical strength compared with the use of autograft.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Cortical Ring Allograft and Plate Fixation with Autologous Iliac Bone Graft for Anterior Cervical Discectomy and Fusion

et al. 2019

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Study Design A retrospective cohort study. Purpose To compare the clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) supplemented with plate fixation using allograft with those who underwent ACDF using tricortical iliac autograft. Overview of Literature As plate fixation is becoming popular, it is reported that ACDF using allograft may have similar outcomes compared with ACDF using autograft. Methods Forty-one patients who underwent ACDF supplemented with plate fixation were included in this study. We evaluated 24 patients who used cortical ring allograft filled with demineralized bone matrix (DBM) (group A) and 17 patients who used tricortical iliac autograft (group B). In radiological evaluations, fusion rate, subsidence of grafted material, cervical lordosis, fused segmental lordosis, and radiological adjacent segment degeneration (ASD) were observed and analyzed with preoperative and postoperative plain radiographs. Clinical outcomes were evaluated using the Neck Disability Index score, Odom criteria, and Visual Analog Scale score of neck and upper extremity pain. Radiological union was determined by dynamic radiographs using cutoff values of 1 mm of interspinous motion as the indication of pseudarthrosis. Results There was no significant difference in the fusion rate, graft subsidence, cervical lordosis, fused segmental lordosis, and ASD incidence between the groups. Operative time was shorter in group A (136 min) than in group B (141 min), but it was not significant ( p >0.05). Blood loss was greater in group B (325 mL) than in group A (210 mL, p =0.013). There was no difference in the clinical outcomes before and after surgery. Conclusions In ACDF with plate fixation, cortical ring allograft filled with DBM group showed similar radiological and clinical outcomes compared with those of the autograft group. If the metal plate is reinforced, using cortical ring allograft could be a viable alternative to autograft.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of Cortical Ring Allograft and Plate Fixation with Autologous Iliac Bone Graft for Anterior Cervical Discectomy and Fusion

et al. 2019

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“…In the case of two-level ACDF using 4 mm as the reference, the presence of subsidence was defined when the difference was larger than 4 mm ( Fig. 1 ) 21) .…”

Section: Methodsmentioning

confidence: 99%

A Prospective Study with Cage-Only or Cage-with-Plate Fixation in Anterior Cervical Discectomy and Interbody Fusion of One and Two Levels

Kim

Yoon

Kim

et al. 2017

J Korean Neurosurg Soc

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ObjectiveThe authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes.MethodsA total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs: subsidence, C2–C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain.ResultsIn the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups: however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425); fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31).ConclusionOur clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

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“…Many studies reported that subsidence rate varies between 23.4-50.5% 27 , 44) . There has been reported the risk factors associated with subsidence.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcome of a Zero-profile Device Comparing with Stand-alone Cage and Anterior Cervical Plate with Iliac Bone Graft in the Anterior Cervical Discectomy and Fusion

Shin

Cho

2014

Korean J Spine

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ObjectiveA Zero-profile device is a cervical stand-alone cage with integrated segmental fixation device. We characteristically evaluated the radiological changes as well as clinical outcomes in the application of Zero-profile devices compared with stand-alone cages and anterior cervical plates with iliac bone grafts for the cervical disease.MethodsRetrospectively, total 60 patients at least more than one year follow-up were enrolled. Twenty patients were treated with Zero-profile devices (Group A), twenty patients with stand-alone cages (Group B) and twenty patients with anterior cervical plates and iliac bone grafts (Group C) for a single level cervical disease. The clinical outcomes were evaluated by Odom's criteria and Bazaz-Yoo dysphagia index. The radiologic parameters were by subsidence and the changes of the midpoint interbody height (IBH), the segmental kyphotic angle (SKA), the overall kyphotic angle (OKA) in index level.ResultsAlthough there was no significant clinical difference according to the Odom's criteria among them(p=0.766), post-operative dysphagia was significantly decreased in the Group A and B compared with the Group C (p=0.04). From the immediate postoperative to the last follow-up time, the mean change of IBH decrement and SKA increment were significant in the Group B compared with the Group A (p=0.025, p=0.033) and the Group C (p=0.001, p=0.000). The subsidence rate was not significant among all groups (p=0.338).ConclusionThis Zero-profile device is a valuable alternative to the anterior cervical discectomy and fusion with a low incidence of postoperative dysphagia and without segmental kyphotic change.

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Radiologic Changes of Anterior Cervical Discectomy and Fusion Using Allograft and Plate Augmentation: Comparison of Using Fixed and Variable Type Screw

Cited by 14 publications

References 22 publications

Comparison of Cortical Ring Allograft and Plate Fixation with Autologous Iliac Bone Graft for Anterior Cervical Discectomy and Fusion

Comparison of Cortical Ring Allograft and Plate Fixation with Autologous Iliac Bone Graft for Anterior Cervical Discectomy and Fusion

A Prospective Study with Cage-Only or Cage-with-Plate Fixation in Anterior Cervical Discectomy and Interbody Fusion of One and Two Levels

Surgical Outcome of a Zero-profile Device Comparing with Stand-alone Cage and Anterior Cervical Plate with Iliac Bone Graft in the Anterior Cervical Discectomy and Fusion

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