Anterior cervical fusion with carbon fiber cage containing coralline hydroxyapatite: preliminary observations in 45 consecutive cases of soft-disc herniation

2002 ◽  
Vol 96 (3) ◽  
pp. 273-276 ◽  
Author(s):  
Umberto Agrillo ◽  
Luciano Mastronardi ◽  
Fabrizio Puzzilli
Keyword(s):  
Carbon Fiber ◽  
Bone Substitutes ◽  
Anterior Cervical Fusion ◽  
Angular Deformity ◽  
Cervical Fusion ◽  
Content Type ◽  
Preliminary Results ◽  
Coralline Hydroxyapatite ◽  
The Mean ◽  
Fine Print

Object. The purposes of bone substitutes for anterior cervical fusion (ACF) are immediate biomechanical support and osteointegration of the graft. The authors report their preliminary results in performing ACF in which carbon fiber cages (CFCs) containing coralline hydroxyapatite (HA) are used as bone substitute. Methods. During a 24-month period, anterior microsurgical discectomy was performed in 45 consecutive patients for soft-disc cervical herniation. In all cases ACF was performed using a CFC containing a core of granulated coralline HA. Fifty-seven CFCs were implanted in 33 single-level and 12 two-level procedures. The mean operative time was 83 minutes for one-level and 97 minutes for two-level procedures. The mean hospital stay was 1.51 days, and there were no permanent complications. At a mean follow up of 22.3 months, the pain had decreased or disappeared in all patients, and the patients' satisfaction rate was very high. Good results were also obtained in patients who smoked cigarettes. Patients underwent radiographic evaluation at Day 1, and 1, 3, 6, and 12 months postoperatively. Implant-related complications were not observed and revision surgeries were not performed. Twelve-month cervical x-ray films demonstrated complete fusion in all cases, without evidence of breakage, collapse, pseudarthrosis, subsidence, angular deformity, or protrusion. Signs of pathological absorption and necrosis were not found in contiguous vertebral bodies, and inflammatory reactions were never seen around cages. Conclusions. These preliminary results suggest that implants composed of CFC containing granulated coralline HA are promising bone substitutes to be used in ACF, with a good rate of incorporation and no significant complications.

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.

Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage

2001 ◽  
Vol 95 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Ronald H. M. A. Bartels ◽  
Roland Donk ◽  
Roel van Dijk Azn
Keyword(s):  
Carbon Fiber ◽  
Statistical Significance ◽  
Mean Value ◽  
Disc Space ◽  
Content Type ◽  
Wedge Shape ◽  
The Mean ◽  
Foraminal Height ◽  
Tomography Scanning ◽  
Fine Print

Object. The authors evaluate the effects of implantation of a carbon fiber cage after anterior cervical discectomy (ACD) on the height of the foramen and the angulation between endplates of the disc space. Methods. Thirteen consecutive patients who were scheduled for standard microscopic ACD and interbody fusion underwent thin-slice (1.5 mm) spiral computerized tomography scanning 1 day preoperatively, 1 day postoperatively, and 1 year postoperatively. Oblique sagittal reconstructions were made through both foramina; the height of each foramen and the angle between the endplates were measured. Because 16 cages were implanted, 32 foramina were investigated. Preoperatively, the mean height of the foramina (± standard deviation) was 8.1 ± 1.5 mm (range 5.7–12 mm), and at 1 day postoperatively it was 9.7 ± 1.4 mm (range 7.5–12.8 mm). This difference reached statistical significance (p < 0.0005). The mean foraminal height after 1 year was 9.4 ± 1.4 mm (range 6.9–12.7 mm). In terms of the preoperative value, the 1-year measurement still reached statistical difference (p < 0.005) but not with the direct postoperative mean foraminal height. Preoperatively the mean value of the angle between the two adjacent endplates was 1.3 ± 2.4° (range 0–8°), and postoperatively it was 7.8 ± 2.9° (range 2–12°), which was statistically significant (p < 0.0005). Conclusions. The cervical carbon fiber cage effectively increased the height of the foramen even after 1 year, which contributed to decompression of the nerve root. The wedge shape of the device may contribute to restoration of lordosis.

Monitoring of blood parameters following anterior cervical fusion

2000 ◽  
Vol 92 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Steffen K. Rosahl ◽  
Alireza Gharabaghi ◽  
Peter-Michael Zink ◽  
Madjid Samii
Keyword(s):  
Cervical Spine ◽  
Cell Count ◽  
Postoperative Period ◽  
White Cell Count ◽  
Anterior Cervical Fusion ◽  
Anterior Fusion ◽  
Cervical Fusion ◽  
Content Type ◽  
Cervical Spine Surgery ◽  
Fine Print

Object. Both C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) were measured prospectively in 51 cases in which uncomplicated cervical anterior fusion was performed. The object of the authors was to quantify the differences in the responses of these parameters recorded in the immediate postoperative period and to determine factors influencing their course. Methods. Nineteen one-level, 23 two-level, and nine three-level procedures for disc herniation and degenerative disease of the cervical spine were performed in 22 female and 29 male patients (mean age 49.2 years). Blood samples were obtained 1 day before as well as on 10 consecutive days and 3 months following anterior cervical fusion. Serum CRP level was measured using a fluorescence polarization immunoassay and ESR was determined from the same samples. Operative time, the number of blood transfusions, and drugs administered in the postoperative period were recorded. In addition, hemoglobin, hematocrit, red blood cell count, platelet count, white cell count, and axillary body temperature were checked daily. Conclusions. Monitoring of CRP level is superior to that of ESR for early detection of infections after cervical spine surgery. Although CRP was not related to any of the factors that have been proposed to explain its peak value variance in previous studies, individual acute-phase protein metabolism response to tissue affection appears to be a more decisive element in this respect.

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.

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.

A modified drill guide for the anterior cervical fusion (Cloward) procedure

1980 ◽  
Vol 52 (2) ◽  
pp. 284-285 ◽  
Author(s):  
Henry Berry ◽  
William J. Horsey
Keyword(s):  
Surgical Procedure ◽  
Anterior Cervical Fusion ◽  
Drilling Process ◽  
Cervical Fusion ◽  
Content Type ◽  
Fusion Procedure ◽  
Cloward Procedure ◽  
Drill Guide ◽  
Fixation Points ◽  
Fine Print

✓ A modified drill guide for use in the anterior cervical fusion procedure is described. This device permits an inspection of the interbody hole during the drilling process, and incorporates the additional mechanical improvements of replacement fixation points and locking rings of different diameter. These modifications have been found to simplify and improve control over the drilling component of this surgical procedure.

Iliac crest fracture after removal of two bone plugs for anterior cervical fusion

1979 ◽  
Vol 51 (4) ◽  
pp. 560-561 ◽  
Author(s):  
Fabio Reale ◽  
Domenico Gambacorta ◽  
Giorgio Mencattini
Keyword(s):  
Vertebral Body ◽  
Iliac Crest ◽  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Content Type ◽  
Fusion Operation ◽  
Fine Print ◽  
Cervical Vertebral Body

✓ A case is reported in which the iliac crest fractured following removal of two bone plugs. The plugs had been removed for use in a double cervical vertebral body fusion operation by the method of Cloward.

Cervical myelopathy due to spondylosis

1978 ◽  
Vol 48 (2) ◽  
pp. 297-301 ◽  
Author(s):  
John C. Hawkins ◽  
F. Yaghmai ◽  
R. Arthur Gindin
Keyword(s):  
Cervical Myelopathy ◽  
Clinical Course ◽  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Content Type ◽  
Cloward Procedure ◽  
Fine Print

✓ The authors report the case of a patient with cervical myelopathy who was examined at autopsy 2 years after a second anterior cervical fusion by Cloward's technique. The clinical course and pre- and postoperative myelograms are presented. Theories as to the etiology of myelopathy are discussed. This case demonstrates chronic changes that seem to implicate a vascular theory but not the specific vessel or vessels. The mechanism of improvement following the Cloward procedure is not explained by the pathological slides.

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.

Vertebral trephine: a new instrument for anterior cervical fusion

1984 ◽  
Vol 60 (6) ◽  
pp. 1315-1316
Author(s):  
Kirpal S. Mann
Keyword(s):  
Anterior Cervical Fusion ◽  
Cervical Fusion ◽  
Content Type ◽  
New Instrument ◽  
Fine Print

✓ A simple yet versatile instrument for anterior cervical fusion is described.

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