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.

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.

Stabilizing effect of posterior lumbar interbody fusion cages before and after cyclic loading

2000 ◽  
Vol 92 (1) ◽  
pp. 87-92 ◽  
Author(s):  
Annette Kettler ◽  
Hans-Joachim Wilke ◽  
Rupert Dietl ◽  
Matthias Krammer ◽  
Christianto Lumenta ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Axial Rotation ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Content Type ◽  
Flexion Extension ◽  
Stabilizing Effect ◽  
Fine Print

Object. The function of interbody fusion cages is to stabilize spinal segments primarily by distracting them as well as by allowing bone ingrowth and fusion. An important condition for efficient formation of bone tissue is achieving adequate spinal stability. However, the initial stability may be reduced due to repeated movements of the spine during everyday activity. Therefore, in addition to immediate stability, stability after cyclic loading is of remarkable relevance; however, this has not yet been investigated. The object of this study was to investigate the immediate stabilizing effect of three different posterior lumbar interbody fusion cages and to clarify the effect of cyclic loading on the stabilization. Methods. Before and directly after implantation of a Zientek, Stryker, or Ray posterior lumbar interbody fusion cage, 24 lumbar spine segment specimens were each evaluated in a spine tester. Pure lateral bending, flexion—extension, and axial rotation moments (± 7.5 Nm) were applied continuously. The motion in each specimen was measured simultaneously. The specimens were then loaded cyclically (40,000 cycles, 5 Hz) with an axial compression force ranging from 200 to 1000 N. Finally, they were tested once again in the spine tester. Conclusions. In general, a decrease of movement in all loading directions was noted after insertion of the Zientek and Ray cages and an increase of movement after implantation of a Stryker cage. In all three cage groups greater stability was demonstrated in lateral bending and flexion than in extension and axial rotation. Reduced stability during cyclic loading was observed in all three cage groups; however, loss of stability was most pronounced when the Ray cage was used.

Vulnerability of the subcostal nerve to injury during bone graft harvesting from the iliac crest

2004 ◽  
Vol 1 (1) ◽  
pp. 87-89 ◽  
Author(s):  
Dean Chou ◽  
Phillip B. Storm ◽  
James N. Campbell
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Donor Site ◽  
Autologous Bone Graft ◽  
Content Type ◽  
Bone Harvesting ◽  
Cutaneous Branch ◽  
Bone Graft Harvesting ◽  
Autologous Bone ◽  
Fine Print

Object. Autologous bone graft harvesting from the iliac crest remains the gold standard for fusion surgery. One disadvantage of autologous bone harvesting is the patient's enduring postoperative pain at the donor site. Nerve injury is one of the postulated mechanisms that may account for this pain. The object of this study was to determine whether the lateral cutaneous branch of the subcostal nerve is vulnerable to injury in the process of obtaining grafts from the anterior iliac crest. Methods. Anatomical dissections were performed on 10 cadaveric specimens to ascertain the size of the T-12 subcostal nerve and its position in relation to the iliac crest. Conclusions. The lateral cutaneous branch of the subcostal nerve may lie as close as 6 cm from the anterior superior iliac spine. This nerve is very vulnerable to injury when harvesting bone from the anterior iliac crest. Knowledge of the anatomy may decrease the risk of injury to this nerve.

Influence of an artificial cervical joint compared with fusion on adjacent-level motion in the treatment of degenerative cervical disc disease

2002 ◽  
Vol 96 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Crispin Wigfield ◽  
Steven Gill ◽  
Richard Nelson ◽  
Ilana Langdon ◽  
Newton Metcalf ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Sagittal Plane ◽  
Autologous Bone Graft ◽  
Intervertebral Discs ◽  
Cervical Disc ◽  
Adjacent Level ◽  
Disc Disease ◽  
Content Type ◽  
Flexion Extension ◽  
Fine Print

Object. The authors report the preservation of motion at surgically treated and adjacent spinal segments after placing an artificial cervical joint (ACJ) and they describe the influence of interbody fusion on changes in angulation occurring in the sagittal plane at adjacent levels in the treatment of cervical spondylosis. Methods. The authors conducted a prospective nonrandomized study of patients in whom an ACJ was placed or autologous bone graft interbody fusion was performed. Angular measurements at levels adjacent to that surgically treated were calculated using plain flexion—extension radiographs obtained at 6-month intervals. Analyses of qualitative data, such as increase or decrease in adjacent-level motion, and the degree of disc degeneration were performed. Quantitative data were also analyzed. In the fusion group a significant increase in adjacent-level movement was demonstrated at the 12-month follow-up visit compared with the group of patients in whom ACJs were placed (p < 0.001). The increase in movement occurred predominantly at intervertebral discs that were preoperatively regarded as normal (p < 0.02). An overall reduction in adjacent-level movement was observed in patients who underwent joint replacement, although this was compensated for by the movement provided by the ACJ itself. Conclusions. Fusion results in increased motion at adjacent levels. The increase in adjacent-level motion derives from those discs that appear radiologically normal prior to surgery. It remains unknown whether ACJs have a protective influence on adjacent intervertebral discs.

Bone morphogenetic protein—2 application by a poly(d,l-lactide)—coated interbody cage: in vivo results of a new carrier for growth factors

2002 ◽  
Vol 97 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Frank Kandziora ◽  
Hermann Bail ◽  
Gerhard Schmidmaier ◽  
Georg Schollmeier ◽  
Matti Scholz ◽  
...  
Keyword(s):  
Growth Factors ◽  
Interbody Fusion ◽  
Callus Formation ◽  
Collagen Sponge ◽  
Bone Morphogenetic Protein 2 ◽  
Content Type ◽  
Titanium Cage ◽  
Morphogenetic Protein ◽  
Flexion Extension ◽  
Fine Print

Object. Growth factors such as bone morphogenetic protein—2 (BMP-2) have been proven to promote spine fusion and to overcome the disadvantages of an autologous bone graft. The optimum method to deliver such growth factors remains a matter of discussion. The purpose of this study was to determine the safety and efficacy of a new poly(d,l-lactide) (PDLLA) carrier system for BMP-2 and to compare this carrier system with a collagen sponge carrier in a sheep cervical spine interbody fusion model. Methods. Thirty-two sheep underwent C3–4 discectomy and fusion: Group 1, titanium cage (eight animals); Group 2, titanium cage coated with a PDLLA carrier (eight animals); Group 3, titanium cage coated with a PDLLA carrier including BMP-2 (150 µg) (eight animals); and Group 4, titanium cage combined with a collagen sponge carrier including BMP-2 (150 µg) (eight animals). Blood samples, body weight, and temperature were assessed. Radiographs were obtained 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 the sheep were killed 12 weeks postoperatively, flexion—extension radiography was performed to evaluate fusion sites. Quantitative computerized tomography scans were obtained to assess bone mineral density (BMD), bone mineral content (BMC), and bone callus volume (BCV). Biomechanical testing was performed in flexion, extension, axial rotation, and lateral bending. Stiffness, range of motion, neutral, and elastic zone were determined. Histomorphological and -morphometrical analyses were performed, and polychrome sequential labeling was used to determine the timeframe of new bone formation. There were no differences among the groups concerning blood counts, body weight, and temperature. Compared with the noncoated cages, all PDLLA-coated cages showed significantly higher values for BMD of the callus, as well as slightly higher values for BMC, BCV, and the bone volume/total volume ratio. In comparison with the cage-alone group, the BMP-2 groups showed significantly higher values for BMD and biomechanical stiffness. Histomorphological, -morphometrical, and polychrome sequential labeling analyses demonstrated greater progression of callus formation in the BMP-2 groups than in any other group. Compared with BMP-2 delivered using a collagen sponge carrier, BMP-2 application with a PDLLA carrier resulted in a higher BCV and a greater progression of interbody callus formation in the histomorphometrical analysis. Conclusions. The use of cervical spine interbody fusion cages coated with PDLLA as a delivery system for growth factors was effective. In this 12-week follow-up study, the PDLLA coating showed no adverse effects. The slight but not significant positive effect of the PDLLA carrier on interbody fusion might be a result of the degradation process of the biodegradable carrier. Compared with collagen sponge delivery of BMP-2, the PDLLA-coated interbody cages significantly increased the results of interbody bone matrix formation. In this new combination (implant + PDLLA + growth factor) the cage represents a “real fusion” cage, because it not only serves as a mechanical device for spinal fixation but also as a local drug delivery system.

Coralline hydroxyapatite and laminectomy-derived bone as adjuvant graft material for lumbar posterolateral fusion

2005 ◽  
Vol 3 (4) ◽  
pp. 271-275 ◽  
Author(s):  
Chien-Jen Hsu ◽  
Wen-Ying Chou ◽  
Hsiu-Peng Teng ◽  
Wei-Ning Chang ◽  
Yi-Jiun Chou
Keyword(s):  
Bone Graft ◽  
Fusion Rate ◽  
Posterolateral Fusion ◽  
Final Decision ◽  
Graft Material ◽  
Chi Square ◽  
Content Type ◽  
Coralline Hydroxyapatite ◽  
Flexion Extension ◽  
Fine Print

Object. The purpose of this study was to evaluate the effectiveness of coralline hydroxyapatite (CHA) and laminectomy-derived bone as an adjuvant graft material when combined with autogenous iliac bone graft (AIBG) in posterolateral fusion (PLF). Methods. This prospective, case—control study involved 58 patients who underwent lumbar instrumentation-augmented PLF for degenerative spinal stenosis—induced segmental instability between July 2000 and June 2001. The patients were divided into three groups. Laminectomy bone and AIBG were placed in the right intertransverse process space in Group 1 (20 patients), CHA and AIBG were placed in Group 2 (19 patients), and laminectomy bone and CHA were placed in Group 3 (19 patients). Pure autogenous iliac cancellous bone graft was placed in the left intertransverse process space in all three groups of patients. Successful fusion was determined by two spine surgeons after examining the plain, anteroposterior, bilateral oblique, and lateral flexion—extension radiographs. If the examiners did not agree on fusion status, fine-cut computerized tomography scans of the fusion mass were used to make the final decision. The chi-square test was used to compare the fusion rate at different time intervals among the three groups. Conclusions. Pure AIBG placed in left intertransverse process space was associated with the best fusion rate. After 6 months, CHA produced a comparable result to laminectomy-derived bone when combined with AIBG. When laminectomy bone was mixed with CHA, the combination failed to yield a satisfactory fusion rate (57.9%) even 1 year after surgery if no AIBG was added.

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.

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