Comparison of Fusion Rates between Autologous Iliac Bone Graft and Calcium Sulfate with Laminectomy Bone Chips in Multilevel Posterolateral Spine Fusion

Introduction. Adjacent segment infective spondylodiscitis is a rare type of surgical spinal infection after lumbar fusion with few reports. We report a further case of adjacent segment infection after three-level lumbar fusion managed successfully with anti-infective therapy and revision surgery. Case Description. A clinical case of a 69-year-old female with multilevel lumbar degenerative disease received three-level fusion. The leading preoperative symptoms were relieved after decompression surgery. However, severe back pain recurred and prompted her to be rehospitalized 2 months later. The signal of spondylitis and discitis at the adjacent segment was detected by magnetic resonance imaging (MRI). No bacteria were identified despite blood cultures being taken before antibiotic treatment. After a long-term anti-infective therapy with vancomycin, the patient gained symptom relief and was discharged home. However, the patient complained of severe back pain again after long-term oral antibiotic treatment and was rehospitalized 6 months after surgery. The computed tomography (CT) scan showed obvious bony endplate destruction at the adjacent segment space. The patient received a debridement operation and autologous iliac bone graft. The infective inflammatory markers were controlled, and the infective space achieved fusion finally. Conclusion. Adjacent segment space infection is a rare reported complication that occurs after spinal fusion surgery. Conservative antibiotic therapy may not control the infection completely, and disc space debridement and autologous iliac bone graft can achieve ultimate fusion and a satisfactory outcome.

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Autologous Iliac Bone Graft With Anterior Plating Is Advantageous Over the Stand-Alone Cage for Segmental Lordosis in Single-Level Cervical Disc Disease

Neurosurgery ◽

10.1227/neu.0b013e31827b94d4 ◽

2012 ◽

Vol 72 (2) ◽

pp. 257-266 ◽

Cited By ~ 33

Author(s):

Chi Heon Kim ◽

Chun Kee Chung ◽

Seokyung Hahn

Keyword(s):

Bone Graft ◽

Iliac Bone ◽

Cervical Disc ◽

Cervical Disc Disease ◽

Disc Disease ◽

Single Level ◽

Plate Group ◽

Iliac Bone Graft ◽

Cage Group ◽

Autologous Iliac Bone Graft

Abstract BACKGROUND: Anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft and plating has been a standard surgical method for single-level cervical disc disease. The stand-alone cage was introduced to reduce graft-related morbidity. However, problems due to focal kyphosis at the operated level have been on the rise. It has been difficult to derive a conclusive answer from previous studies for the indications of each method. OBJECTIVE: An interim analysis of a prospective randomized study was performed to compare the sagittal alignment between a stand-alone cage (ACDF cage) and autologous iliac bone graft and plating (ACDF plate). METHODS: Twenty-nine patients were allocated to the ACDF-cage group (M:F = 17:12) and 23 to the ACDF-plate group (M:F = 14:9). Cobb angles at the operated segment (segmental angle, SA; lordosis vs kyphosis) were compared at postoperative 12 months and the other confounding factors were explored. RESULTS: Demographic features were not different between groups. The fusion method significantly affected segmental alignment at 12 months (P = .03; odds ratio, 5.52). Preoperatively, the SA was not different between the groups (P = .18) and was similar (P = .22) immediately following the operation. However, the SA was significantly more lordotic (P < .05) in the ACDF-plate group at postoperative 12 months in comparison with the ACDF-cage group. There was no other significant risk factor for segmental kyphosis. CONCLUSION: The stand-alone cage and autologous bone graft with plating had similar clinical outcomes, but stand-alone cage fusion may be disadvantageous from a radiological viewpoint.

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