Creation and operation of a bone bank

1970 ◽  
Vol 33 (6) ◽  
pp. 682-688 ◽  
Author(s):  
Ralph B. Cloward
Keyword(s):  
Bone Graft ◽  
Interbody Fusion ◽  
Bone Bank ◽  
Content Type ◽  
Adequate Supply ◽  
Operation And Maintenance ◽  
Anterior Interbody Fusion ◽  
Reliable Source ◽  
Fine Print

✓ The author states that sterile frozen cadaver bone has proven to be a superior bone graft for anterior (interbody) fusion operations on the spine. An adequate supply of good quality bone is necessary, and a bone bank can be an important and reliable source. The author reviews his 22-year experience with bone banks and gives details for their creation, operation, and maintenance.

Technique for obtaining iliac bone graft for anterior cervical fusion

1974 ◽  
Vol 41 (2) ◽  
pp. 260-261 ◽  
Author(s):  
Maurice W. Nicholson
Keyword(s):  
Bone Graft ◽  
Operative Technique ◽  
Interbody Fusion ◽  
Iliac Crest ◽  
Cervical Fusion ◽  
Content Type ◽  
Iliac Bone Graft ◽  
Graft Removal ◽  
Bone Dowels ◽  
Fine Print

✓ Modifications in the operative technique for removing bone dowels from the iliac crest for anterior cervical interbody fusion are described. The technique has been successful in alleviating hip pain following graft removal.

Influence of cage design on interbody fusion in a sheep cervical spine model

2002 ◽  
Vol 96 (3) ◽  
pp. 321-332 ◽  
Author(s):  
Frank Kandziora ◽  
Georg Schollmeier ◽  
Matti Scholz ◽  
Jan Schaefer ◽  
Alexandra Scholz ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Mineral ◽  
Interbody Fusion ◽  
Iliac Crest ◽  
Bone Matrix ◽  
Iliac Crest Bone Graft ◽  
Disc Space ◽  
Content Type ◽  
Flexion Extension ◽  
Fine Print

Object. The purpose of this study was to compare the characteristics of interbody fusion achieved using an autologous tricortical iliac crest bone graft with those of a cylinder- and a box-design cage in a sheep cervical spine model. This study was designed to determine whether there are differences between three interbody fusion procedures in: 1) ability to preserve postoperative distraction; 2) biomechanical stability; and 3) histological characteristics of intervertebral bone matrix formation. Methods. Twenty-four sheep underwent C3–4 discectomy and fusion in which the following were used: Group 1, autologous tricortical iliac crest bone graft (eight sheep); Group 2, titanium cylinder-design cage filled with autologous iliac crest bone graft (eight sheep); and Group 3, titanium box-design cage filled with autologous iliac crest graft (eight sheep). Radiography was performed pre- and postoperatively and after 1, 2, 4, 8, and 12 weeks. At the same time points, disc space height, intervertebral angle, and lordosis angle were measured. After 12 weeks, the sheep were killed, and fusion sites were evaluated by obtaining functional radiographs in flexion and extension. Quantitative computerized tomography scans were acquired to assess bone mineral density, bone mineral content, and bone callus volume. Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending. Stiffness, range of motion, neutral zone, and elastic zone were determined. Histomorphological and histomorphometric analyses were performed, and polychrome sequential labeling was used to determine the time frame of new bone formation. Over a 12-week period significantly higher values for disc space height and intervertebral angle were shown in cage-treated sheep than in those that received bone graft. Functional radiographic assessment revealed significantly lower residual flexion—extension movement in sheep with the cylinder cage-fixed spines than in those that received bone graft group. The cylinder—design cages showed significantly higher values for bone mineral content, bone callus content, and stiffness in axial rotation and lateral bending than the other cages or grafts. Histomorphometric evaluation and polychrome sequential labeling showed a more progressed bone matrix formation in the cylindrical cage group than in both other groups. Conclusions. Compared with the tricortical bone graft, both cages showed significantly better distractive properties. The cylindrical cage demonstrated a significantly higher biomechanical stiffness and an accelerated interbody fusion compared with the box-design cage and the tricortical bone graft. The differences in bone matrix formation within both cages were the result of the significantly lower stress shielding on the bone graft by the cylinder-design cage.

Trans-unco-discal approach

1976 ◽  
Vol 45 (3) ◽  
pp. 284-291 ◽  
Author(s):  
Akira Hakuba
Keyword(s):  
Cervical Spine ◽  
Surgical Technique ◽  
Bone Graft ◽  
Interbody Fusion ◽  
Lateral Approach ◽  
Content Type ◽  
Special Cases ◽  
Unstable Cervical Spine ◽  
Fine Print

✓ A series of 40 patients with degenerative discopathy was effectively treated by means of a trans-unco-discal approach, which is a combined anterior and lateral approach to cervical discs. Interbody fusion is not performed except for special cases such as significant kyphosis and unstable cervical spine. Twenty patients who had this approach without interbody bone graft have been followed clinically and radiographically for 9 to 36 months. The author describes the surgical technique, complications, and results.

Cervical arthroplasty after previous surgery: results of treating 24 discs in 15 patients

2005 ◽  
Vol 3 (5) ◽  
pp. 335-341 ◽  
Author(s):  
Lali H. S. Sekhon ◽  
William Sears ◽  
Neil Duggal
Keyword(s):  
Interbody Fusion ◽  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Cervical Arthroplasty ◽  
Content Type ◽  
Anterior Interbody Fusion ◽  
Posterior Foraminotomy ◽  
Fine Print

Object. The potential role of cervical arthroplasty in patients who have undergone previous cervical surgery is unknown. The authors performed a prospective study involving nonrandomized clinical and radiological assessment in patients who had undergone either previous posterior cervical foraminotomy or anterior interbody fusion and who suffered new or persistent arm/neck symptoms related to neural compression. Methods. During a 30-month period, 15 patients who had previously undergone cervical spinal surgery underwent cervical arthroplasty that involved placement of the Bryan disc for neck or arm symptoms related to cervical disc disease. A total of 24 devices were implanted. Six of the 15 patients had undergone a previous posterior foraminotomy, and in nine cases an anterior interbody fusion had been perfomed at some stage prior to surgery. Clinical and radiological evaluations were performed preoperatively and after surgery to assess outcomes. A total of 24 arthroplasties were performed encompassing between one and three levels. There were no major perioperative complications or immediate device-related failures. Two patients were lost to follow up. The follow-up period ranged from 12 to 43 months (mean 24.2 ± 10.5 months). Good results were obtained in all cases as reflected by an increase in the visual analog scale score of 6.4 in terms of neck/arm pain (p < 0.05). There was no difference in Oswestry Disability Index scores for neck pain (p > 0.05) and no patient required surgery at the same level. In one patient hypermobility developed with internal subluxation of the device, which suggested a compromise adjacent to a two-level fusion at 21 months. The segment was hypermobile preoperatively. The patient has experienced recurrent neck pain but otherwise remains clinically well and has not required revision surgery to date. Conclusions. Insertion of the Bryan artificial cervical disc in patients who have previously undergone cervical fusion or posterior foraminotomy, in general, appears to be safe. It provided encouraging early clinical results, although patients with preoperative hypermobility should be treated with caution. Issues such as accelerated device-related wear and the use of arthroplasty after aggressive facetectomy resection will need further study; however, in carefully selected patients who have undergone previous surgery cervical arthroplasty may provide an additional tool in the management of cervical disc disease.

Retroperitoneal lateral lumbar interbody fusion with titanium threaded fusion cages

2002 ◽  
Vol 96 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Christopher E. Wolfla ◽  
Dennis J. Maiman ◽  
Frank J. Coufal ◽  
James R. Wallace
Keyword(s):  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Fusion Rate ◽  
Lumbar Interbody Fusion ◽  
Anterior Longitudinal Ligament ◽  
Content Type ◽  
Single Cage ◽  
Novel Technique ◽  
Methodological Problems ◽  
Fine Print

Object. Intertransverse arthrodesis in which instrumentation is placed is associated with an excellent fusion rate; however, treatment of patients with symptomatic nonunion presents a number of difficulties. Revision posterior and traditional anterior procedures are associated with methodological problems. For example, in the latter, manipulation of the major vessels from L-2 to L-4 may be undesirable. The authors describe a method for performing retroperitoneal lumbar interbody fusion (LIF) in which a threaded cage is placed from L-2 through L-5 via a lateral trajectory, and they also detail a novel technique for implanting a cage from L-5 to S-1 via an oblique trajectory. Although they present data obtained over a 2-year period in the study of 15 patients, the focus of this report is primarily on describing the surgical procedure. Methods. The lateral lumbar spine was exposed via a standard retroperitoneal approach. Using the anterior longitudinal ligament as a landmark, the L2–3 through L4–5 levels were fitted with instrumentation via a true lateral trajectory; the L5—S1 level was fitted with instrumentation via an oblique trajectory. A single cage was placed at each instrumented level. Fifteen symptomatic patients in whom previous lumbar fusion had failed underwent retroperitoneal LIF. Thirty-eight levels were fitted with instrumentation. There have been no instrumentation-related failures, and fusion has occurred at 37 levels during the 2-year postoperative period. Conclusions. The use of retroperitoneal LIF in which threaded fusion cages are used avoids the technical difficulties associated with repeated posterior procedures. In addition, it allows L2—S1 instrumentation to be placed anteriorly via a single surgical approach. This construct has been shown to be biomechanically sound in animal models, and it appears to be a useful alternative for the management of failed multilevel intertransverse arthrodesis.

Beta—tricalcium phosphate as a substitute for autograft in interbody fusion cages in the canine lumbar spine

2002 ◽  
Vol 97 (3) ◽  
pp. 350-354 ◽  
Author(s):  
Takashiro Ohyama ◽  
Yoshichika Kubo ◽  
Hiroo Iwata ◽  
Waro Taki
Keyword(s):  
Lumbar Spine ◽  
Tricalcium Phosphate ◽  
Interbody Fusion ◽  
Donor Site ◽  
Posterolateral Approach ◽  
Content Type ◽  
Spine Model ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. An interbody fusion cage has been introduced for cervical anterior interbody fusion. Autogenetic bone is packed into the cage to increase the rate of union between adjacent vertebral bodies. Thus, donor site—related complications can still occur. In this study a synthetic ceramic, β—tricalcium phosphate (TCP), was examined as a substitute for autograft bone in a canine lumbar spine model. Methods. In 12 dogs L-1 to L-4 vertebrae were exposed via a posterolateral approach, and discectomy and placement of interbody fusion cages were performed at two intervertebral disc spaces. One cage was filled with autograft (Group A) and the other with TCP (Group B). The lumbar spine was excised at 16 weeks postsurgery, and biomechanical, microradiographic, and histological examinations were performed. Both the microradiographic and histological examinations revealed that fusion occurred in five (41.7%) of 12 operations performed in Group A and in six (50%) of 12 operations performed in Group B. The mean percentage of trabecular bone area in the cages was 54.6% in Group A and 53.8% in Group B. There were no significant intergroup differences in functional unit stiffness. Conclusions. Good histological and biomechanical results were obtained for TCP-filled interbody fusion cages. The results were comparable with those obtained using autograft-filled cages, suggesting that there is no need to harvest iliac bone or to use allo- or xenografts to increase the interlocking strength between the cage and vertebral bone to achieve anterior cervical interbody fusion.

The effects of dexamethasone on bone fusion in an experimental model of posterolateral lumbar spinal arthrodesis

2001 ◽  
Vol 94 (1) ◽  
pp. 76-81 ◽  
Author(s):  
Paul D. Sawin ◽  
Curtis A. Dickman ◽  
Neil R. Crawford ◽  
M. Stephen Melton ◽  
William D. Bichard ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Bone Graft ◽  
Spinal Fusion ◽  
Experimental Model ◽  
Content Type ◽  
Bone Fusion ◽  
Group 12 ◽  
Spinal Arthrodesis ◽  
Lumbar Spinal ◽  
Fine Print

Object. The use of corticosteroid agents during the healing phase after spinal arthrodesis remains controversial. Although anecdotal opinion suggests that corticosteroids may inhibit bone fusion, such an effect has not been substantiated in clinical trials or laboratory investigations. This study was undertaken to delineate the effect of exogenous corticosteroid administration on bone graft incorporation in an experimental model of posterolateral lumbar fusion. Methods. An established, well-validated model of lumbar intertransverse process spinal fusion in the rabbit was used. Twenty-four adult New Zealand white rabbits underwent L5–6 bilateral posterolateral spinal fusion in which autogenous iliac crest bone graft was used. After surgery, the animals were randomized into two treatment groups: a control group (12 rabbits) that received intramuscular injections of normal saline twice daily and a dexamethasone group (12 rabbits) that received intramuscular dexamethasone (0.05 mg/kg) twice daily. After 42 days, the animals were killed and the integrity of the spinal fusions was assessed by radiography, manual palpation, and biomechanical testing. In seven (58%) of the 12 control rabbits, solid posterolateral fusion was achieved. In no dexamethasone-treated rabbits was successful fusion achieved (p = 0.003). Tensile strength and stiffness of excised spinal segments were significantly lower in dexamethasone-treated animals than in control animals (tensile strength 91.4 ± 30.6 N and 145.3 ± 48.2, respectively, p = 0.004; stiffness 31.4 ± 11.6 and 45.0 ± 15.2 N/mm, respectively, p = 0.02). Conclusions. The corticosteroid agent dexamethasone inhibited bone graft incorporation in a rabbit model of single-level posterolateral lumbar spinal fusion, inducing a significantly higher rate of nonunion, compared with that in saline-treated control animals.

Safety of transforaminal lumbar interbody fusion and intervertebral recombinant human bone morphogenetic protein—2

2005 ◽  
Vol 3 (6) ◽  
pp. 436-443 ◽  
Author(s):  
Alan T. Villavicencio ◽  
Sigita Burneikiene ◽  
E. Lee Nelson ◽  
Ketan R. Bulsara ◽  
Mark Favors ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Bone Morphogenetic Protein 2 ◽  
Content Type ◽  
Morphogenetic Protein ◽  
Human Bone Morphogenetic Protein ◽  
Recombinant Human Bone ◽  
Fine Print

Object. Recombinant human bone morphogenetic protein—2 (rhBMP-2) is being increasingly used for spinal fusion. There are few data regarding its clinical safety, effectiveness, and clinical outcome when applied on an absorbable collagen sponge (ACS) in conjunction with allograft for transforaminal lumbar interbody fusion (TLIF). Methods. Seventy-four consecutive patients undergoing TLIF for degenerative disc disease were divided into five groups depending on whether the patient underwent a minimally invasive or open approach, as well as the number of spinal levels surgically treated. Surgery-related data, fusion results, complications, and clinical outcome were evaluated. The mean follow-up duration was 20.6 months (range 14–28 months). The radiographic fusion rate was 100% at 12 and 24 months after the surgery. No bone overgrowth or other complications related to BMP use were demonstrated. Conclusions. Analysis of the results demonstrated that TLIF combined with a BMP-2—soaked ACS is a feasible, effective, and safe method to promote lumbar fusion. There were no significant intergroup differences in clinical outcome between patients who underwent open compared with minimally invasive procedures. Patient satisfaction rates, however, were higher in the minimally invasive procedure group. The efficacy of BMP-2 was not dependent on which approach was used or the number of spinal levels that were treated.

Current status of bone graft options for anterior interbody fusion of the cervical and lumbar spine

2013 ◽  
Vol 37 (1) ◽  
pp. 23-37 ◽  
Author(s):  
Anthony Minh Tien Chau ◽  
Lileane Liang Xu ◽  
Johnny Ho-Yin Wong ◽  
Ralph Jasper Mobbs
Keyword(s):  
Lumbar Spine ◽  
Bone Graft ◽  
Interbody Fusion ◽  
Current Status ◽  
Anterior Interbody Fusion

Resorbable polymer implants in unilateral transforaminal lumbar interbody fusion

2002 ◽  
Vol 97 (4) ◽  
pp. 464-467 ◽  
Author(s):  
Thomas G. Lowe ◽  
Jeffrey D. Coe
Keyword(s):  
Adverse Events ◽  
Biodegradable Polymers ◽  
Clinical Studies ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Degenerative Disease ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
Fine Print

Object. Sixty patients underwent instrumentation-assisted posterior transforaminal lumbar interbody fusion (TLIF) with resorbable polymer cages and autograft bone for degenerative disease. This article discusses the technique of TLIF and its early outcomes. Methods. Although the follow-up period is short and results are preliminary, no adverse events or complications were attributed to the resorbable polymer. Conclusions. Further multicenter clinical studies are underway with a minimum 2-year follow-up period chosen as an endpoint to provide insight as to the future of biodegradable polymers as spinal interbody devices.

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