The Availability of Autogenous Bicortical Iliac Bone Graft in Anterior Cervical Interbody Fusion

Dong-Jun Kim; Jong-Oh Kim; Yeo-Hon Yun; Young-Do Koh; Nam-Ki Kim

doi:10.1874/JKSS.2021.19.4.158

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

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

Original Research

J Korean Soc Spine Surg 2012;19(4):158-163.

Published online: 18 December 2012

DOI: https://doi.org/10.1874/JKSS.2021.19.4.158

The Availability of Autogenous Bicortical Iliac Bone Graft in Anterior Cervical Interbody Fusion

Dong-Jun Kim, M.D., Jong-Oh Kim, M.D., Yeo-Hon Yun, M.D., Young-Do Koh, M.D., Nam-Ki Kim, M.D.

Department of Orthopaedic Surgery, Graduate School of Medicine, Ewha Womans University, Seoul, Korea

Corresponding author: Jong-Oh Kim, M.D. Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, 911-1 MokDong, YangCheon-Ku, Seoul, Korea TEL: 82-2-2650-5529, FAX: 82-2-2642-0349 E-mail: osjokim@chol.com

Received 5 October 201211 October 2012 Accepted 12 December 2012

“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

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.

Keywords: Cervical spine, Anterior interbody fusion, Autogenous bicortical bone graft, Cervical locking plate

REFERENCES

1.Wang JM., Kim DJ. Clinical Course of Iliac Bone Graft Donor Site Morbidity. J Korean Soc Spine Surg. 1996. 3:154–60.

2.Kim DJ., Shin MC. Long-Term Follow-up of Posterior Pedicle Instrumentation and Anterior Lumbar Fusion using a Bicortical Iliac Allograft. J Korean Orthop Assoc. 2003. 38:594–600.

3.Song KJ., Choi BW., Kim SJ., Yoon SJ. Cross-Cultural Ad-aptation and Validation of the Korean Version of the Neck Disability Index. J Korean Orthop Assoc. 2009. 44:350–9.

4.Brantigan JW. Pseudoarthrosis rate after allograft posterior lumbar interbody fusion with pedicle screw and plate fixation. Spine (Phila Pa 1976). 1994. 19:1271–9.

5.Sasso RC., LeHuec JC., Shaffrey C. Iliac Crest Bone Graft Donor Site Pain After Anterior Lumbar Interbody Fusion: A Prospective Patient Satisfaction Outcome Assessment. J Spinal Disord Tech. 2005. 18:77–81.

6.Myeroff C., Archdeacon M. Autogenous Bone Graft: Donor Sites and Techniques. J Bone Joint Surg Am. 2011. 93:2227–36.

7.Fasolis M., Boffano P., Ramieri G. Morbidity associated with anterior iliac crest bone graft. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012. 114:586–91.

8.Lee JK., Ahn JS., Kim SB., Hong CH., Lee JB. Influence of Plate Position on Fusion Time and Clinical Outcomes after Anterior Cervical Interbody Fusion. J Korean Soc Spine Surg. 2005. 12:22–7.

9.Wang JC., McDonough PW., Endow K., Kanim LE., Dela-marter RB. The effect of cervical planting on single-level anterior cervical discectomy and fusion. J Spinal Disord. 1999. 12:467–71.

10.Fernandes HM., Mendelow AD., Choksey MS. Anterior cervical discectomy: an improvement in donor site operative technique. Br J Neurosurg. 1994. 8:201–3.

Fig. 1.

Photograph shows autogenous bicortical iliac bone harvested during operation.

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.

Fig. 3.

Preoperative and postoperative neck pain in time sequnece

Fig. 4.

Postoperative donor site pain in time sequence

Fig. 5.

Preoperative and postoperative NDI in time sequnece

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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