The Use of Allograft and Recombinant Human Bone Morphogenetic Protein for Instrumented Atlantoaxial Fusions

Hood, Brian; Hamilton, D. Kojo; Smith, Justin S.; Dididze, Marine; Shaffrey, Christopher I.; Levi, Allan D.

doi:10.1016/j.wneu.2013.01.083

Cited by 17 publications

(13 citation statements)

References 19 publications

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“…40 Similarly, in a series that predominantly described PCF in adults with screw/rod constructs, Hood et al reported a 100% fusion rate in 52 patients when BMP and allograft were combined. 69 Similar fusion rates have been reported for OCF in adult patients using allograft as well. 104 The findings of these large adult series confirm the trend seen in the pediatric literature: the use of allograft for OCF and PCF results in high fusion rates when combined with rigid internal fixation, with or without the use of BMP.…”

Section: Publication Biassupporting

confidence: 74%

“…Many reports of successful OCF and PCF with allograft in adults also used BMP to promote fusion. 39,69 Similarly, BMP was combined with allograft in the vast majority of OCF and PCF, resulting in successful fusion that we report in this review. Interestingly, the use of BMP was not statistically correlated with successful fusion in any of our univariate or multivariate analyses, when evaluating all OCF and PCF cases collectively or separately.…”

Section: The Role Of Bmp In Allograft Fusionsmentioning

confidence: 80%

“…67,69,73,93 The use of autograft has long been considered the "gold standard" for OCF and PCF in children, and its use continues to be advocated by many surgeons. 1,50,58,67,150 As recently as 2005, authors have considered the use of onlay allograft to be inappropriate for OCF.…”

Section: Publication Biasmentioning

confidence: 99%

“…11,82,138,140 While there was a dearth of publications related to the use of allograft in pediatric cervical spine fusions for the 2 decades that followed the early failures reported in the 1980s, there has been a resurgence in interest over the most recent decade corresponding to the widespread use of rigid internal fixation techniques and the availability of BMP. 56,69,73,78,88,151 Emboldened by the greater fusion rates associated with screw-based constructs, with or without the use of BMP, there has been a sharp rise in publications describing OCF and PCF in children and adults. Our review confirmed that fusion rates greater than 90% have been routinely reported with pediatric OCF and PCF when allograft is used with rigid internal fixation.…”

Section: Publication Biasmentioning

confidence: 99%

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Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

Reintjes

Amankwah

Rodríguez

et al. 2016

PED

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OBJECT Fusion rates are high for children undergoing posterior cervical fusion (PCF) and occipito-cervical fusion (OCF). Autologous bone has been widely used as the graft material of choice, despite the risk of donor-site morbidity associated with harvesting the bone, possibly because very low fusion rates were reported with posterior allograft cervical fusions in children several decades ago. Higher overall fusion rates using allograft in adults, associated with improvements in internal fixation techniques and the availability of osteoinductive substances such as bone morphogenetic protein (BMP), have led to heightened enthusiasm for the use of bank bone during pediatric PCF. A systematic review was performed to study factors associated with successful bone fusion, including the type of bone graft used. METHODS The authors performed a comprehensive PubMed search of English-language articles pertaining to PCF and OCF in patients less than 18 years old. Of the 561 abstracts selected, 148 articles were reviewed, resulting in 60 articles that had sufficient detail to be included in the analysis. A meta-regression analysis was performed to determine if and how age, fusion technique, levels fused, fusion substrate, BMP use, postoperative bracing, and radiographic fusion criteria were related to the pooled prevalence estimates. A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS A total of 604 patients met the specific inclusion and exclusion criteria. The overall fusion rate was 93%, with a mean age of 9.3 years and mean follow-up of 38.7 months. A total of 539 patients had fusion with autograft (94% fusion rate) and 65 patients with allograft (80% fusion rate). Multivariate meta-regression analysis showed that higher fusion rates were associated with OCF compared with fusions that excluded the occiput (p < 0.001), with the use of autograft instead of allograft (p < 0.001), and with the use of CT to define fusion instead of plain radiography alone. The type of internal fixation, the use of BMP, patient age, and the duration of follow-up were not found to be associated with fusion rates in the multivariate analysis. CONCLUSIONS Fusion rates for PCF are high, with higher rates of fusion seen when autograft is used as the bone substrate and when the occiput is included in the fusion construct. Further study of the use of allograft as a viable alternative to autograft bone fusion is warranted because limited data are available regarding the use of allograft in combination with more rigid internal fixation techniques and osteoinductive substances, both of which may enhance fusion rates with allograft.

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Section: Publication Biassupporting

confidence: 74%

Section: The Role Of Bmp In Allograft Fusionsmentioning

confidence: 80%

Section: Publication Biasmentioning

confidence: 99%

Section: Publication Biasmentioning

confidence: 99%

See 2 more Smart Citations

Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

Reintjes

Amankwah

Rodríguez

et al. 2016

PED

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“…As a special part of the cervical spine in human body, atlantoaxial complex bears approximately 50% of rotary motion and 12% of flexion and extension movement of the cervical spine [1]. Without intervertebral disc between the atlas and the axis, the stability of atlantoaxial complex relies solely on the atlantoaxial joint and the transverse ligament [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Gallie technique versus atlantoaxial screw-rod constructs in the treatment of atlantoaxial sagittal instability: a retrospective study of 49 patients

et al. 2017

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BackgroundThe objectives of this study are to investigate the clinical curative effect of Gallie technique and atlantoaxial screw-rod constructs (SRC) on atlantoaxial sagittal instability and determine the indication of Gallie technique.MethodsData of 49 patients with atlantoaxial sagittal instability from February 2008 to May 2015 were analyzed retrospectively. The visual analog scale (VAS) score and the neck disability index (NDI) were used to evaluate the curative effect. Postoperative radiological outcomes were used to evaluate the stability of atlantoaxial joint and bone fusion. Perioperative parameters such as blood loss, operation time, radiographic exposure times, and hospital expense were also recorded and analyzed.ResultsForty-nine patients (36 men and 13 women) were included in this study. The mean age was 41.4 ± 8.9 (range from 19 to 64). All patients were followed up for 24–67 months. Among these patients, 25 of these patients underwent Gallie surgery and 24 underwent SRC surgery. The pain in the occipitocervical area of all the patients has been relieved. NDI scores and VAS scores were lower in Gallie group than in SRC group in early postoperative period. The proportion of the patients who achieved good bone fusion within 3 months after operation was 88.0% (22/25) in the Gallie group and 100% (24/24) in the SRC group. The Gallie group is lower than the SRC group in blood loss, operation time, radiographic exposure times, and hospital expense. Statistical difference was observed between the two groups.ConclusionsFor patients with atlantoaxial instability who has (1) the atlantodental interval (ADI) which is bigger than 5 mm on lateral flexion-extension X-ray, or Anderson-D’Alonzo type II odontoid fracture, (2) no asymmetry between odontoid process and lateral mass on open-mouth anterior-posterior X-ray, and (3) no dislocation of lateral mass joint on the CT 3D reconstruction, Gallie technique can be chosen as a safe and effective method if atlantoaxial reduction can be achieved preoperatively. Compared with SRC, Gallie technique can relieve the pain in the occipitocervical area earlier and it can shorten operation time and reduce intraoperative bleeding, radiographic exposure times, and hospital expense effectively. However, for patients with irreducible atlantoaxial dislocation, the Gallie technique should be used with caution.

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Atlantoaxial Stabilization

Buchholz¹,

Quinn²,

Shaffrey³

et al. 2018

Degenerative Cervical Myelopathy and Radiculopathy

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The Use of Allograft and Recombinant Human Bone Morphogenetic Protein for Instrumented Atlantoaxial Fusions

Cited by 17 publications

References 19 publications

Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

Gallie technique versus atlantoaxial screw-rod constructs in the treatment of atlantoaxial sagittal instability: a retrospective study of 49 patients

Atlantoaxial Stabilization

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