Clinical and Radiological Outcome Analysis on Anterior Cervical Discectomy and Interbody Fusion Using Hydroxyapatite Block

Jin Gyeong Ha; Jin Hoon Park; Sang Ryong Jeon

doi:10.13004/jknts.2011.7.2.63

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Ha, Park, and Jeon: Clinical and Radiological Outcome Analysis on Anterior Cervical Discectomy and Interbody Fusion Using Hydroxyapatite Block

Clinical Article

Journal of Korean Neurotraumatology Society 2011; 7(2): 63-67.

Published online: 31 October 2011

DOI: https://doi.org/10.13004/jknts.2011.7.2.63

Clinical and Radiological Outcome Analysis on Anterior Cervical Discectomy and Interbody Fusion Using Hydroxyapatite Block

Jin Gyeong Ha, MD, Jin Hoon Park, MD, Sang Ryong Jeon, MD

Department Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Sang Ryong Jeon, MD, PhD. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-3550, Fax: +82-2-476-6738, srjeon@amc.seoul.kr

Received 29 March 2011 Revised 22 August 2011 Accepted 22 August 2011

Abstract

Objective

Although use of autologous iliac bone graft in anterior cervical discectomy and fusion (ACDF) for cervical degenerative diseases remain standard surgical procedure, donor site morbidity are still concerns. Several synthetic graft materials have been developed to prevent this complication. This is retrospective study of clinical and radiological outcomes of ACDF using synthetic hydroxyapatite (HA) block to evaluate the efficacy.

Methods

From May 2009 to June 2010, twenty-one patients (M 11 ; F 10) were enrolled in this study and 35 segments were involved. All patients were performed ACDF using HA block and plating system. Indications of surgery were radiculopathy caused by degenerative cervical spondylosis with or without myelopathy. The mean period of clinical follow-up was 6.6 months (range from 6 to 12 months). The change of Visual Analogue Scale (VAS) and Neck Disability Index (NDI) at 6 month were used for clinical outcome analysis. Cervical spine radiographs including dynamic views were obtained at postoperative 3 day, 1, 3, 6 months in all patients to measure the change of disc height, overall and segmental lordosis, segmental motion. Computed tomography was done at postoperative 6 month in all patients to confirm the radiological fusion.

Results

Mean VAS and NDI score changed from 8.2 to 2.7 and from 23.4 to 10.5, respectively. The mean disc height change was from 4.5 to 7.1. Cervical lordosis and segmental lordosis changes were from 24.4 to 24.5 and from 3.93 to 4.57, respectively. Complete interbody fusion was achieved in 95.2% of patients. There was one case of non-fusion patient.

Conclusion

HA block is very efficient graft material in achieving cervical fusion, maintaining intervertebral disc height for ACDF. Further follow up study should be needed to evaluate the efficacy of this material.

Keywords: Bone fusion, Cervical lordosis, Disc height, Hydroxyapatite block, Cervical intervertebral disk

Figures and Tables

FIGURE 1

A: Mean height=(A+B)/2, A=anterior disc height, B=posterior disc height. B: C spine Stress view.

FIGURE 2

VAS scores (A) and NDI (B) scores were decreased through the follow-up period since surgery. VAS: Visual Analogue Scale, NDI: Neck Disability Index.

FIGURE 3

A: Disc height. Disc height increased after surgery, later decreasing but not returning to preoperative levels. B: Cervical lordosis. Cervical lordosis decreased after surgery, later returning to preoperative levels. C: Segmental lordosis. Segmental lordosis increased immediately after surgery, later decreasing but not returning to preoperative levels.

FIGURE 4

A 52-year-old man who present with cervical radiculopathy and underwent ACDF with HA block. C spine CT scan at A immediately postoperative, B postoperative 6 months visits. Bone briding was formed between vertebral endplates (arrows). ACDF: anterior cervical discectomy and fusion, HA: hydroxyapatite.

TABLE 1

Baseline demographic and clinical characteristics

Osteoporosis: Bone mineral density < T-2.5. DM: diabetes mellitus

TABLE 2

Non-parametric analysis on surgical outcome (VAS)

^*this p-value was calculated from the Man-Whitney U test. OP: operative, M: months, VAS: Visual Analogue Scale

TABLE 3

Non-parametric analysis on surgical outcome (NDI)

^*this p-value was calculated from the Man-Whitney U test. OP: operative, NDI: Neck Disability Index

Notes

The authors have no financial conflicts of interest.

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