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 -

Heui-Jeon Park; Wan-Ki Kim; Young-Jun Shim; Dong-Hyun Kang

doi:10.4184/JKSS.2010.17.3.111

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Park, Kim, Shim, and Kang: 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 -

Original Research

J Korean Soc Spine Surg 2010;17(3):111-119.

Published online: 18 September 2010

DOI: https://doi.org/10.4184/JKSS.2010.17.3.111

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 -

Heui-Jeon Park, M.D., Wan-Ki Kim, M.D., Young-Jun Shim, M.D., Dong-Hyun Kang, M.D.

Department of Orthopaedic Surgery, Yonsei University, Wonju College of Medicine, Wonju, Korea

Corresponding author: Heui-Jeon, Park M.D. Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, 162 Ilsan-dong, Wonju, Kangwon-do, Korea TEL: 82-33-741-1352, FAX : 82-33-741-1358 E-mail: par73@wonju.yonsei.ac.kr

Received 15 December 200921 June 2010 Accepted 7 July 2010

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

This is a retrospective study.

Objectives

We wanted to evaluate the effectiveness and safety of a PEEK cage filled with DBM in patients with a distractive flexion injury of the cervical spine.

Summary of the Literature Review

AIF of the cervical spine using an autoiliac bone graft and plate fixation is known to be an effective treatment for traumatic injuries. However, the complications arising from the donor site are troublesome, and so fusion with cage is an alternative treatment.

Materials and Methods

We analyzed 32 cases (22 males and 10 females) with distractive flexion injury of the cervical spine. They underwent anterior decompression and interbody fusion with a PEEK cage and anterior plate fixation. In 18 patients, the cage was filled with autogenous iliac bone (Group I), and for the other 10 the cages were filled with DBM (Group II).

Results

All the cases in Group I and Group II achieved fusion except for one case of nonunion in group II. The anterior and posterior vertebral heights of the fused segments of group II were decreased more than those of group I, resulting a statistical difference (p=0.003). The changes of segmental lordosis (p=0.69) and the neurologic status (p=0.22) showed no statistical difference between the two groups.

Conclusions

AIF using a PEEK cage filled with DBM and plate fixation showed no significant clinical differences compared to the case of iliac bone autografting. However, from a radiologic perspective, the time to achieve union was extensive and a case of nonunion was also observed. Therefore, many considerations are necessary when using DBM as a replacement for iliac bone autografting and further research should be done on this subject.

Keywords: Cervical spine, Distractive flexion injury, Anterior interbody fusion, DBM graft

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Fig. 1.

Radiograph showing linear and angular measurement.

Fig. 2.

A 43-year old male with C5 nerve root injury due to bilateral facet dislocation. (A) Preoperative lateral roentgenogram shows anterior displacement of C5 on C6 body. (B) T2 weighted sagittal MR image shows a C5-6 disc protrusion. (C) Lateral radiograph, immediately after surgery, shows anterior cervical fusion with cervical spine locking plate and Solis PEEK cage that packed with cancellous iliac bone. (D,E) Lateral roentgenogram of flexion/extension views that show no motion and solid fusion.

Fig. 3.

A 19-year old male with C5 nerve root injury due to unilateral facet dislocation. (A) Preoperative lateral roentgenogram shows anterior displacement of C4 on C5 body. (B) T2 weighted sagittal MR image shows a C4-5 disc protrusion. (C) Lateral radiograph, immediately after surgery, shows anterior cervical fusion with cervical spine locking plate and Solis PEEK cage that packed with demineralized bone matrix. (D,E) Lateral roentgenogram of flexion/extension views that show no motion and solid fusion.

Fig. 4.

A 49-year old female with spinal cord injury due to unilateral facet dislocation. (A) Preoperative lateral roentgenogram shows anterior displacement of C5 on C6 body. (B) T2 weighted sagittal MR image shows a C5-6 disc protrusion and a change of spinal cord signal. (C) Lateral radiograph, immediately after surgery, shows anterior cervical fusion with cervical spine locking plate and Solis PEEK cage that packed with demineralized bone matrix. (D,E) Lateral roentgenogram of flexion/extension views that show transverse radiolucent line and 5.2˚ fusion segmental motion.

Table 1.

Demography of patients

		Autobone group (n=18)	DBM group (n=14)	P-value
Age (years)		46.1±15.3	43.4±18.7	0.25
Sex (M/F)		12/6	10/4	0.77
Smoking		9	5	0.42
Follow up (months)		19.1±9.2	18.7±7.7	0.23
	C4-5(C3-4)	4	3
Fusion level	C5-6	9	7	0.98
	C6-7	6	4

Table 2.

Change of local lordosis and body height between two groups

		Autobone group (n=18)	DBM group (n=14)	P-value
Lordotic angle (°)	Postoperation.	5.6±4.1	6.6±4.3	0.69
	Last F/U	5.0±4.0	6.9±5.9
	Change of angle(Δ)	-0.5±3.6	0.2±2.9
Ant. body height (ABH^＊,%)	Postoperation.	2.4±0.2	2.5±0.3	0.81
	Last F/U	2.3±0.2	2.4±0.3
	Change of Ht.(Δ)^†	-7.4±9.3	-13.8±9.2
Post. body height (PBH^＊,%)	Postoperation	2.3±0.2	2.4±0.2	0.003
	Last F/U	2.2±0.1	2.2±0.2
	Change of Ht.(Δ)^†	-8.2±6.5	-21.6±19.5

^∗ ABH(%)= Anterior body height/Control height ×100

^∗ PBH(%)= Posterior body height/Control height ×100

^† Change of Ht.(Δ) ABH(%) = LastF/U ABH - Postop.ABH/Postop. ABH ×100

^† Change of Ht.(Δ) ABH(%) = LastF/U PBH - Postop.PBH/Postop.PBH ×100

Table 3.

Change of neurological examination

		Autobone group (n=18)	DBM group (n=14)	P-value
ASIA score	Initial	75.7±24.6	82.1±28.7	0.68
	Last F/U	84.1±18.7	85.6±25.7	0.86
	Change of score(Δ)	8.3±8.7	3.4±4.0	0.22

Table 4.

Union rate and union period

	Autobone group (n=18)	DBM group (n=14)	P-value
Bony union rate (%)	100% (18/18)	93% (13/14)
Bony union period (weeks)	13.0±1.4	20.8±2.3	0.01

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