A Comparative Study of the Anterior Cervical Fusion with Harms Cage versus Iliac Bone Block: Clinical and Radiological Outcomes

Jae-Yoon Chung; Ji-Hyeon Yim; Hyoung-Yeon Seo; Sung-Kyu Kim; Seung-Hun, Lee

doi:10.4184/jkss.2011.18.4.186

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Chung, Yim, Seo, Kim, and Lee: A Comparative Study of the Anterior Cervical Fusion with Harms Cage versus Iliac Bone Block: Clinical and Radiological Outcomes

Original Article

Journal of Korean Spine Surg 2011;18(4):186-194.

Published online: 21 December 2011

DOI: https://doi.org/10.4184/jkss.2011.18.4.186

A Comparative Study of the Anterior Cervical Fusion with Harms Cage versus Iliac Bone Block: Clinical and Radiological Outcomes

Jae-Yoon Chung, M.D., Ji-Hyeon Yim, M.D., Hyoung-Yeon Seo, M.D., Sung-Kyu Kim, M.D., Seung-Hun, Lee, M.D.

Department of Orthopedic Surgery, Chonnam National University Medical School, Gwangju, Korea

Corresponding author: Ji-Hyeon Yim, M.D. Department of Orthopaedic Surgery, Chonnam National University Hospital, 8 Hak-dong, Dong-gu, Gwangju, 501-757, Korea TEL: 82-62-220-6336, FAX: 82-62-225-7794 E-mail: presid50@naver.com

Received 25 June 2011 Revised 27 October 2011 Accepted 10 November 2011

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

A retrospective study.

Objectives

To evaluate the clinical and radiological outcomes of anterior cervical fusion within Harms cage versus an iliac bone block graft.

Summary of Literature Review

There is no current consensus regarding the optimal material for anterior cervical fusion.

Materials and Methods

This was a single-center study of 107 patients who either underwent anterior cervical fusion with an iliac bone block graft (n=56; group A) or a cancellous bone graft within the cervical Harms titanium cage (n=51; group B). Anterior plating occurred in all cases. Clinical outcomes and complications were evaluated using Visual Analogue Scale (VAS) scores and Odom's Criteria. Radiological outcomes were evaluated by the height of vertebral bodies, sagittal lordosis, the rate of bony union, and the subsidence of cage.

Results

The VAS of donor site pain was significantly higher in group A than in group B at the final followup. Sagittal lordosis was increased in both groups, but was significantly higher in group B than group A. The rate of bony union was 95% and 91% for both groups 6 months after surgery and reached 100% for both groups at the final followup. In terms of cage subsidence, the highest point of subsidence was at the inferior and posterior aspect of the cage and the average amount of subsidence was approximately 1.3 mm at final followup.

Conclusions

Anterior cervical fusion using a cancellous bone graft within Harms titanium cage is a good method for anterior cervical fusion with iliac bone block.

Keywords: Anterior cervical fusion, Harms titanium cage, Iliac bone block

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Fig. 1.

Photograph of the trephine which is using tool for cancellous bone harvest.

Fig. 2.

Lateral radiograph of cervical spine showing vertebral height measuring method of operation segment (a+b / 2) and segmental alignment measuring method (Cobb's angle of A & B).

Fig. 3.

Lateral radiograph of cervical spine showing cage subsidence measuring method which is checked a difference of gap that right angle distance from each edge of cage to screw for one level (A) and two levels (B).

Fig. 4.

Serial radiographs of 57-year-old male patient underwent C6/7 anterior cervical fusion using Harms cage with anterior plating. Preoperative (A) and immediate postoperative radiograph (B) show increased disc height in C6/7. Follow radiographs (C) at 6 months showing solid union.

Fig. 5.

Graph showing the clinical outcome analysis with Visual Analogue Scale(VAS) for donor site pain.

Fig. 6.

Graph showing the change of average segmental height for one level and two levels.

Fig. 7.

Graph showing the change of average sagittal segmental alignment for one level and two levels.

Fig. 8.

Graph showing the change of average subsidence of Harms titanium cage for one level and two levels.

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