The surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies

1994 ◽  
Vol 80 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Toyohiko Isu ◽  
Kyosuke Kamada ◽  
Nobuaki Kobayashi ◽  
Shoji Mabuchi
Keyword(s):  
Surgical Technique ◽  
Donor Site ◽  
Bone Grafts ◽  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Disc Disease ◽  
Nerve Roots ◽  
Content Type ◽  
Vertebral Bodies

✓ The authors describe the surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies. This series consisted of 90 patients with cervical intervertebral disc disease suffering from cervical spondylotic myelopathy. Thirty-five patients were operated on at one level, 33 at two levels, and 22 at three levels. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 24 months (range 1 year to 3 years 6 months). Anterior angulation was found in four (4.4%) of the 90 patients. This surgical procedure has two major advantages: 1) there are no complications related to the iliac donor site, allowing early patient mobilization; and 2) the extensive posterior spur can be removed safely and easily under a wide operative field without damaging the spinal cord and nerve roots.

A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results

2000 ◽  
Vol 93 (2) ◽  
pp. 222-226 ◽  
Author(s):  
Robert J. Hacker
Keyword(s):  
Interbody Fusion ◽  
Donor Site ◽  
Anterior Cervical Fusion ◽  
Cervical Disc ◽  
Control Group ◽  
Cervical Fusion ◽  
Content Type ◽  
Solid Fusion ◽  
Fine Print

Object. Despite variations in technique, inherent problems persist with current approaches to anterior cervical fusion. This study was performed to determine whether anterior cervical fusion performed using an investigational device was safe and effective in the treatment of degenerative cervical disc disorders and whether this device offered advantages over current techniques. Methods. Fifty-four patients with radiculopathy with or without mild myelopathy due to one- or two-level cervical degenerative disc disease were randomized as part of a Food and Drug Administration device study. Following microsurgical discectomy, the control group was treated with iliac crest graft fusion; the experimental study group underwent insertion of an interspace cage and placement of a local autograft. All patients received postoperative follow-up care for at least 2 years. Good or excellent results were found in approximately 97% of the experimental group and 88% of the control group. A solid fusion was achieved in all patients who underwent one-level cage placement, and a solid fusion at one or both levels was achieved in over 90% of both groups. Chronic donor site pain was reported by 31% of the control group. Conclusions. In this study, the use of an interbody fusion cage avoided donor site morbidity and placement of autograft achieved a high rate of good or excellent results. Interbody fusion cages appear safe and effective, and their use helps to avoid some of the inherent problems in performing current anterior cervical fusion techniques.

A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions

1998 ◽  
Vol 88 (2) ◽  
pp. 255-265 ◽  
Author(s):  
Paul D. Sawin ◽  
Vincent C. Traynelis ◽  
Arnold H. Menezes
Keyword(s):  
Comparative Analysis ◽  
Iliac Crest ◽  
Donor Site ◽  
Wound Dehiscence ◽  
Bone Grafts ◽  
Fusion Rate ◽  
Donor Site Morbidity ◽  
Cervical Fusion ◽  
Content Type ◽  
Fine Print

Object. Autogeneic bone graft is often incorporated into posterior cervical stabilization constructs as a fusion substrate. Iliac crest is used frequently, although donor-site morbidity can be substantial. Rib is used rarely, despite its accessibility, expandability, unique curvature, and high bone morphogenetic protein content. The authors present a comparative analysis of autogeneic rib and iliac crest bone grafts, with emphasis on fusion rate and donor-site morbidity. Methods. A review was conducted of records and radiographs from 600 patients who underwent cervical spinal fusion procedures in which autogeneic bone grafts were used. Three hundred patients underwent rib harvest and posterior cervical fusion. The remaining 300 patients underwent iliac crest harvest (248 for an anterior cervical fusion and 52 for posterior fusion). The analysis of fusion focused on the latter subgroup; donor-site morbidity was determined by evaluating the entire group. Fusion criteria included bony trabeculae traversing the donor—recipient interface and long-term stability on flexion—extension radiographs. Graft morbidity was defined as any untoward event attributable to the graft harvest. Statistical comparisons were facilitated by using Fisher's exact test. Conclusions. Demographic data obtained in both groups were comparable. Rib constructs were placed in the following regions: occipitocervical (196 patients), atlantoaxial (35 patients), and subaxial cervical spine (69 patients). Iliac crest grafts were placed in the occipitocervical (28 patients), atlantoaxial (10 patients), and subaxial cervical (14 patients) regions. Fusion occurred in 296 (98.8%) of 300 rib graft and 49 (94.2%) of 52 iliac crest graft constructs (p = 0.056). Graft morbidity was greater with iliac crest than with rib (p < 0.00001). Donor-site morbidity for the rib graft was 3.7% and included pneumonia (eight patients), persistent atelectasis (two patients), and superficial wound dehiscence (one patient). Pneumothorax, intercostal neuralgia, and chronic chest wall pain were not encountered. Iliac crest morbidity occurred in 25.3% of the patients and consisted of chronic donor-site pain (52 patients), wound dehiscence (eight patients), pneumonia (seven patients), meralgia paresthetica (four patients), hematoma requiring evacuation (three patients), and iliac spine fracture (two patients). Even when chronic pain was not considered, morbidity encountered in obtaining iliac crest still exceeded that encountered with rib harvest (p = 0.035). The fusion rate and donor-site morbidity for rib autograft compare favorably with those for iliac crest when used in posterior cervical constructs. To the authors' knowledge, this represents the largest series to date in which the safety and efficacy of using autogeneic bone graft materials in spinal surgery are critically analyzed.

Graft subsidence after instrument-assisted anterior cervical fusion

2002 ◽  
Vol 97 (2) ◽  
pp. 186-192 ◽  
Author(s):  
Gary W. Tye ◽  
R. Scott Graham ◽  
William C. Broaddus ◽  
Harold F. Young
Keyword(s):  
Smoking Status ◽  
Reoperation Rate ◽  
Anterior Cervical Fusion ◽  
Neurological Deficits ◽  
Cervical Fusion ◽  
Content Type ◽  
Plate Length ◽  
Graft Subsidence ◽  
Fine Print

Object. Bone grafts used in anterior cervical fusion (ACF) may subside postoperatively. The authors reviewed a recent series in which instrument-assisted ACF was performed to determine the degree of subsidence with respect to fusion length, use of segmental screws, and patient smoking status, age, and sex. Methods. Charts and implant records were reviewed for all 70 patients who underwent instrument-assisted ACF during a 2-year period. The procedures, grafting materials, plate types/lengths, and patient smoking status were recorded. The immediate postoperative and follow-up lateral radiographs were analyzed. The plate lengths and lengths of the fused segments were measured in a standardized fashion. The mean intraoperative and follow-up fusion segment lengths were 54.3 and 51.9 mm, respectively. Greater subsidence occurred in multilevel fusions than in single-level fusions. There were noticeable changes in the position of plates or screws on 14 of 70 follow-up x-ray films. No new neurological deficits related to graft subsidence occurred, and the reoperation rate was 3%. There was no statistical relation between subsidence and the following variables: segmental fixation, smoking status, sex, age, or dowel size when corrected for length of the plate. Hardware migration correlated significantly with plate length in cases of two- and three-level fusions. Conclusions. The length of a fusion segment decreases in the immediate weeks following instrument-assisted ACF. Construct length is the most important determinant of subsidence. When designing multilevel cervical constructs, consideration of the effects of graft subsidence may help to avoid hardware-related complications.

scholarly journals Two-level cervical arthroplasty using a “no-distraction” technique

2017 ◽  
Vol 42 (videosuppl1) ◽  
pp. V1
Author(s):  
Deshpande Rajakumar ◽  
Ankit Sharma ◽  
Akshay Hari ◽  
Subhas Konar ◽  
Murali Krishna
Keyword(s):  
Surgical Technique ◽  
Neck Pain ◽  
Vertebral Body ◽  
Degenerative Disease ◽  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Cervical Arthroplasty ◽  
Motion Preservation ◽  
Link Type

Cervical arthroplasty is being recognized as an emerging alternative to anterior cervical fusion with comparable or superior outcomes. The authors describe the surgical nuances of 2-level cervical arthroplasty in a case of 2-level degenerative disease. In this surgical technique, conventional vertebral body distraction has been avoided to prevent facet distraction, which can be a cause of persistent postoperative neck pain. Good motion preservation was observed at the 1-year follow-up examination.The video can be found here: https://youtu.be/YTpRVRXuZZk.

Use of cylindrical titanium mesh and locking plates in anterior cervical fusion

2001 ◽  
Vol 94 (1) ◽  
pp. 174-178 ◽  
Author(s):  
Kaushik Das ◽  
William T. Couldwell ◽  
Gerard Sava ◽  
Rudolph F. Tadonio
Keyword(s):  
Cervical Spine ◽  
Iliac Crest ◽  
Locking Plate ◽  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Titanium Mesh ◽  
Content Type ◽  
Locking Plate System ◽  
Fine Print

✓ After performing anterior cervical corpectomy or discectomy for cervical spondolytic myelopathy or radiculopathy, iliac crest bone graft and fibular auto- or allograft is often used to achieve arthrodesis in the cervical spine. The purpose of this study was to evaluate the use of a cylindrical titanium mesh and locking plate system as an alternative technique in achieving anterior cervical fusion and maintaining lordosis. Hospital records and radiographs of 38 patients who underwent anterior cervical discectomies (28 patients) or corpectomies (10 patients) from 1995 to 1997 were reviewed retrospectively. All patients had undergone arthrodesis in which autograft and a cylindrical titanium mesh and anterior locking plate fixation were used after discectomy or corpectomy. There were 20 men and 18 women (mean age 46.1 years; range 34–72 years). Presenting symptoms included radiculopathy (61%), myelopathy (37%), and neck pain (2%). Preoperative and postoperative radiographs were studied, and data were obtained on the following: overall lordosis or kyphosis of the cervical spine, segmental lordosis or kyphosis at each surgically treated level, and evidence of fusion. In all of the patients in whom lordosis was present preoperatively, lordosis was maintained during the follow-up period. The overall fusion rate was 100%. The average change in overall lordosis or kyphosis related to the fixation devices was 1.2° (range 1–5°); the average segmental change was 2.3° (range 0–5°); and the mean follow up was 16 months (range 12–36 months). Anterior cervical fusion with cylindrical titanium mesh and cervical locking plate system is an effective method of achieving arthrodesis and maintaining alignment in the cervical spine. The construct may provide additional load-sharing function, and it avoids the use of cadaveric bone or the need for harvesting tricortical iliac crest autograft.

Fracture of the anterior superior iliac spine following anterior cervical fusion using iliac crest

1978 ◽  
Vol 48 (5) ◽  
pp. 809-810 ◽  
Author(s):  
Arden F. Reynolds ◽  
Paul T. Turner ◽  
John D. Loeser
Keyword(s):  
Iliac Crest ◽  
Donor Site ◽  
Anterior Cervical Fusion ◽  
Anterior Superior Iliac Spine ◽  
Cervical Fusion ◽  
Content Type ◽  
Anterior Discectomy ◽  
The Right ◽  
Anterior Discectomy And Fusion ◽  
Fine Print

✓ A case is presented in which fracture of the right anterior superior iliac spine occurred 2 weeks after the right iliac crest had been used as the donor site for a two-level anterior discectomy and fusion.

Multilevel anterior cervical fusion using skull bone grafts

1992 ◽  
Vol 76 (2) ◽  
pp. 298-302 ◽  
Author(s):  
Tokutaro Tanaka ◽  
Toshiaki Ninchoji ◽  
Kenichi Uemura ◽  
Hiroshi Ryu ◽  
Masashi Sugiura ◽  
...  
Keyword(s):  
Bone Grafts ◽  
Cord Compression ◽  
Anterior Cervical Fusion ◽  
Graft Material ◽  
Cervical Fusion ◽  
Skull Bone ◽  
Content Type ◽  
A Minor ◽  
Anterior Decompression And Fusion ◽  
Sufficient Strength

✓ The successful use of autogenous skull bone grafts for a C3–7 anterior cervical fusion is reported and compared with results using other bone grafts. A 51-year-old man with C4–7 anterior cord compression due to spurs and ossified posterior longitudinal ligaments developed progressive tetraparesis following a minor head injury. He underwent anterior decompression and fusion. On two occasions an iliac graft had failed; however, a graft of autogenous skull bone was successful. The skull bone was found superior to bone from other sites, such as the iliac crest, rib, tibia, and fibula, showing sufficient strength and less morbidity. The skull may be a better source of graft material for multilevel anterior cervical fusion, which requires long and strong grafts.

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