Journal List > J Korean Soc Spine Surg > v.19(4) > 1075976

Kim, Kim, Yun, Koh, and Kim: The Availability of Autogenous Bicortical Iliac Bone Graft in Anterior Cervical Interbody Fusion

Abstract

Study Design

Retrospective study.

Objectives

To demonstrate the fusion rate, degree of subsidence and donor site morbidity of anterior cervical interbody fusion with autogenous bicortical iliac bone graft and anterior cervical locking plate.

Summary of Literature Review

In anterior cervical discectomy and fusion with autogenous tricortical iliac bone graft, a large percentage of patients report chronic donor site pain.

Materials and Methods

Retrospective research was done for 39 patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft, from January 2006 to July 2011, with a follow up period of longer than 1 year. Fusion rates and subsidece of the graft is estimated with radiographs. Neck pain and donor site pain was estimated with visual analogue scale (VAS) and dysfunction was estimated with the neck disability index (NDI).

Results

A 95% of patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft revealed definitive fusion with little amount of subsidence. The mean VAS score was 0.7 on the donor site and the mean NDI score was 3.8 at the final visit. There was excellent clinical outcome without complication at the donor site or the recipient site.

Conclusions

Anterior cervical interbody fusion with autogenous bicortical iliac bone graft showed high fusion rates and minimal subsidence with excellent clinical outcomes. Therefore, bicortical iliac bone graft is an effective operational procedure in anterior cervical interbody fusion.

REFERENCES

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Fig. 1.
Photograph shows autogenous bicortical iliac bone harvested during operation.
jkss-19-158f1.tif
Fig. 2. (A)
Preoperative lateral radiograph of a 51–year-old woman with cervical herniated nucleus pulposus of C 5-6. (B) Lateral radiograph of the same patient after an one level anterior fusion operation. (C) Lateral radiograph of the same patient at the last follow-up 1 year after operation. The films show definitive fusion at C5-6 and without grafted bicortical iliac bone collapse.
jkss-19-158f2.tif
Fig. 3.
Preoperative and postoperative neck pain in time sequnece
jkss-19-158f3.tif
Fig. 4.
Postoperative donor site pain in time sequence
jkss-19-158f4.tif
Fig. 5.
Preoperative and postoperative NDI in time sequnece
jkss-19-158f5.tif
Table 1.
Description of Radiographic Fusion Result (by Brantigan,1994)
Radiographic fusion Bone in the fusion area radiographically more dense and more mature than originally achieved in surgery, no interface between the donor bone and the vertebral bone(a sclerotic line between the graft and vertebral bone indicates fusion), mature bony trabeculae bridging the fusion area, resorption of vertebral traction spurs, anterior progression of the within the disc space, fusion of facet joint, the “ring” phenomenon on computed tomography.
Fusion status uncertain Bone graft visible in the fusion area at proximately the density originally achieved surgically, or a small lucency or gap visible involving a portion of the fusion area with at least half of the graft area showing no lucency between the graft bone and vertebral bone.
Radiographic pseudathrosis Collapse of the construct, vertebral slip, broken screws, resorption of the bone graft, or major lucency or gap visible in the fusion area(2mm of more around the entire periphery of the graft or cage)
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