Usefulness of Anterior Cervical Interbody Fusion Using Locally Harvested Bone: Minimum 5-Year Follow-Up

Dae Moo Shim; Tae Kyun Kim; Sung Kyun Oh; Seung Whan Kuk; Bong Jun Jang; Ji Woong Choi

doi:10.4055/jkoa.2016.51.3.191

Journal List > J Korean Orthop Assoc > v.51(3) > 1013442

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Shim, Kim, Oh, Kuk, Jang, and Choi: Usefulness of Anterior Cervical Interbody Fusion Using Locally Harvested Bone: Minimum 5-Year Follow-Up

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(3): 191-198.

Published online: 22 June 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.3.191

Usefulness of Anterior Cervical Interbody Fusion Using Locally Harvested Bone: Minimum 5-Year Follow-Up

Dae Moo Shim, M.D., Tae Kyun Kim, M.D., Sung Kyun Oh, M.D.^*, Seung Whan Kuk, M.D., Bong Jun Jang, M.D., Ji Woong Choi, M.D.

Department of Orthopaedic Surgery, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.

^*Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Gunpo, Korea.

Correspondence to: Sung Kyun Oh, M.D. Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, 327 Sanbon-ro, Gunpo 15865, Korea. TEL: +82-31-390-2224, FAX: +82-31-398-2223, niceo@daum.net

Received 20 May 2015 Revised 25 August 2015 Accepted 10 October 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to determine the usefulness of locally harvested autobone as a filling material for fusion.

Materials and Methods

Retrospective study was conducted for 21 patients diagnosed as cervical disc herniation with cervical myelopathy or radiculopathy who underwent anterior cervical fusion using locally harvested autobone and polyetheretherketone solis cage from June 2006 to September 2009, with a follow-up period of longer than 5 years. Radiologic outcomes were evaluated by the rate of bone union, the change of intervertebral height, and the subsidence of the cage.

Results

In clinical results, visual analogue scale score was 5.8±0.71/7.7±0.78 at preoperative, 1.6±0.58/2.3±0.97 at 1-year follow-up, 1.8±0.81/2.7±1.28 at 5-year follow-up, and neck disability index score was 34.3±6.2 in preoperative stage, 6.25±3.21 at 1-year follow-up, and 6.51±4.05 at 5-year follow-up. Radiologically intervertebral height was reduced from average 6.31±0.93 mm in 1-year follow-up to average 6.22±0.85 mm in 5-year follow-up. Subsidence of cage was average 1.28±0.41 mm at 1-year follow-up and average 1.31±0.43 mm at 5-year follow-up, with no statistically significant difference (p>0.05). Average subsidence of cage in these cases was 3.25 mm. In postoperative complication, screw breakage occurred in 1 case, screw pull out occurred in 1 case, and there was no postoperative infection.

Conclusion

Using locally harvested autobone as filling material for fusion resulted in outstanding bone union and improvement of clinical results. In long term follow-up, there was no significant difference in union rate and complication incidence. Therefore use of locally harvested autobone as a filling material for fusion is considered an effective method.

Keywords: anterior cervical interbody fusion, locally harvested autobone graft, polyetheretherketone cage

Figures and Tables

Figure 1

Intra-operation finding.

Figure 2

Measurement of the radiographic outcome. (A) Lateral radiograph of the cervical spine showing subsidence distance. (B) Lateral radiograph of the cervical spine showing measurements of the segmental lordosis (SL). (C) Lateral radiograph of the cervical spine showing the segmental height measuring method.

Figure 3

Flexion-extension lateral X-ray changes in distance between spinous process less than 2 mm was determined as bone union.

Table 1

Clinical Outcomes

Values are presented as mean±standard deviation. VAS, visual analogue scale; NDI, neck disability index.

Table 2

Radiologic Outcome

Values are presented as mean±standard deviation.

Table 3

Implant Related Complications

Values are presented as number only. ^*Fisher's exact test.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

This work was supported by research grant of Wonkwang University in 2016.

References

1. Kim DH, Jeong ST, An SH, Park HB, Hwang SC, Cho SH. Effectiveness of the new modified smith-robinson bone graft for cervical anterior interbody fusion. J Korean Orthop Assoc. 2008; 43:101–106.

2. Bolesta MJ, Rechtine GR 2nd, Chrin AM. Three- and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine (Phila Pa 1976). 2000; 25:2040–2044. discussion 2045-6.

3. Robinson RA. Anterolateral cervical disc removal and interbody fusion for the cervical disc syndrome. Bull John Hopkins Hosp. 1955; 96:223–224.

4. Lowery GL, McDonough RF. The significance of hardware failure in anterior cervical plate fixation Patients with 2- to 7-year follow-up. Spine (Phila Pa 1976). 1998; 23:181–186.

5. DePalma AF, Rothman RH, Lewinnek GE, Canale ST. Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet. 1972; 134:755–758.

6. Emery SE, Fisher JR, Bohlman HH. Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine (Phila Pa 1976). 1997; 22:2622–2624.

7. Song KJ, Lee KB. A preliminary study of the use of cage and plating for single-segment fusion in degenerative cervical spine disease. J Clin Neurosci. 2006; 13:181–187.

8. Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 2002; 50:229–236. discussion 236-8.

9. Payer M, May D, Reverdin A, Tessitore E. Implantation of an empty carbon fiber composite frame cage after single-level anterior cervical discectomy in the treatment of cervical disc herniation: preliminary results. J Neurosurg. 2003; 98:2 Suppl. 143–148.

10. Pechlivanis I, Thuring T, Brenke C, et al. Non-fusion rates in anterior cervical discectomy and implantation of empty polyetheretherketone cages. Spine (Phila Pa 1976). 2011; 36:15–20.

11. Shim DM, Kim TK, Oh SK, Kim SY, Lee SB. Usefulness of anterior cervical interbody fusion using locally harvested bone: locally harvested bone versus autogenous iliac bone. J Korean Orthop Assoc. 2014; 49:147–152.

12. Brantigan JW. Pseudarthrosis rate after allograft posterior lumbar interbody fusion with pedicle screw and plate fixation. Spine (Phila Pa 1976). 1994; 19:1271–1279. discussion 1280.

13. An HS, Simpson JM, Glover JM, Stephany J. Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion A prospective multicenter study. Spine (Phila Pa 1976). 1995; 20:2211–2216.

14. Kumaresan S, Yoganandan N, Pintar FA, Maiman DJ. Finite element modeling of the cervical spine: role of intervertebral disc under axial and eccentric loads. Med Eng Phys. 1999; 21:689–700.

15. Song KJ, Choi BR, Yang KH, Lee KB. Results of one level anterior cervical discectomy and fusion in the degenerative cervical spinal disorder: comparison of 3 arthrodesis techniques. J Korean Orthop Assoc. 2003; 38:282–288.

16. Suchomel P, Barsa P, Buchvald P, Svobodnik A, Vanickova E. Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern. Eur Spine J. 2004; 13:510–515.

17. Young WF, Rosenwasser RH. An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy. Spine (Phila Pa 1976). 1993; 18:1123–1124.

18. Zdeblick TA, Ducker TB. The use of freeze-dried allograft bone for anterior cervical fusions. Spine (Phila Pa 1976). 1991; 16:726–729.

19. Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity A statistical evaluation. Spine (Phila Pa 1976). 1995; 20:1055–1056.

20. Hacker RJ. Threaded cages for degenerative cervical disease. Clin Orthop Relat Res. 2002; 394:39–46.

21. Matgé G. Cervical cage fusion with 5 different implants: 250 cases. Acta Neurochir (Wien). 2002; 144:539–549. discussion 550.

22. Senter HJ, Kortyna R, Kemp WR. Anterior cervical discectomy with hydroxylapatite fusion. Neurosurgery. 1989; 25:39–42. discussion 42-3.

23. Min WK, Bae JS, Park BC, et al. Proliferation and osteoblastic differentiation of bone marrow stem cells: comparison of vertebral body and iliac crest. Eur Spine J. 2010; 19:1753–1760.

24. Shad A, Leach JC, Teddy PJ, Cadoux-Hudson TA. Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience. J Neurosurg Spine. 2005; 2:116–122.

25. Pitzen T, Kiefer R, München D, Barbier D, Reith W, Steudel WI. Filling a cervical spine cage with local autograft: change of bone density and assessment of bony fusion. Zentralbl Neurochir. 2006; 67:8–13.

26. Chung JY, Yim JH, Seo HY, Kim SK, Lee SH. A comparative study of the anterior cervical fusion with harms cage versus iliac bone block: clinical and radiological outcomes. J Korean Soc Spine Surg. 2011; 18:186–194.

27. Park HJ, Kim WK, Shim YJ, Kang DH. Efficiency of anterior interbody fusion using cage packed with dbm in the distractive flexion injury of cervical spine: demineralized bone matrix vs autoiliac cancellous bone. J Korean Soc Spine Surg. 2010; 17:111–119.

28. Isu T, Kamada K, Kobayashi N, Mabuchi S. The surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies. J Neurosurg. 1994; 80:16–19.

29. Park JI, Cho DC, Kim KT, Sung JK. Anterior cervical discectomy and fusion using a stand-alone polyetheretherketone cage packed with local autobone: assessment of bone fusion and subsidence. J Korean Neurosurg Soc. 2013; 54:189–193.

30. Yang JJ, Yu CH, Chang BS, Yeom JS, Lee JH, Lee CK. Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage. Clin Orthop Surg. 2011; 3:16–23.

TOOLS

Similar articles