A minimum 2-year comparative study of autologous cancellous bone grafting versus beta-tricalcium phosphate in anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage

Abstract

Although titanium stand-alone cages are commonly used in anterior cervical discectomy and fusion (ACDF), there are several concerns such as cage subsidence after surgery. The efficacy of β-tricalcium phosphate (β-TCP) granules as a packing material in 1- or 2-level ACDF using a rectangular titanium stand-alone cage is not fully understood. The purpose of this study is to investigate the validity of rectangular titanium stand-alone cages in 1- and 2-level ACDF with β-TCP. This retrospective study included 55 consecutive patients who underwent ACDF with autologous iliac cancellous bone grafting and 45 consecutive patients with β-TCP grafting. All patients completed at least 2-year postoperative follow-up. Univariate and multivariate analyses were performed to examine the associations between study variables and nonunion after surgery. Significant neurological recovery after surgery was obtained in both groups. Cage subsidence was noted in 14 of 72 cages (19.4 %) in the autograft group and 12 of 64 cages (18.8 %) in the β-TCP group. A total of 66 cages (91.7 %) in the autograft group showed osseous or partial union, and 58 cages (90.6 %) in the β-TCP group showed osseous or partial union by 2 years after surgery. There were no significant differences in cage subsidence and the bony fusion rate between the two groups. Multivariate analysis using a logistic regression model showed that fusion level at C6/7, 2-level fusion, and cage subsidence of grades 2-3 were significantly associated with nonunion at 2 years after surgery. Although an acceptable surgical outcome with negligible complication appears to justify the use of rectangular titanium stand-alone cages in 1- and 2-level ACDF with β-TCP, cage subsidence after surgery needs to be avoided to achieve acceptable bony fusion at the fused segments. Fusion level at C6/7 or 2-level fusion may be another risk factor of nonunion.

Biological action of calcium phosphate grafts on the spine

“…A retrospective study by Yamagata et al included 55 consecutive patients who underwent anterior cervical discectomy and fusion with titanium cages with the use of autologous iliac crest bone grafting and 45 consecutive patients with TCP-β grafting. With a minimum 2-year follow-up, there were no differences in fusion rates, neurological outcome and cage subsidence between the 2 groups 29 . Anterior cervical fusion with interbody cages containing TCP-β is associated with successful fusion seen in all patients at 6 months follow-up 30 .…”

Influence of prevertebral soft tissue swelling on dysphagia after anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage

“…The surgical procedure was described in our previous publications. [ 5 7 22 ] Briefly, patients were placed in the supine position under general anesthesia. In cases of severe anterior compression, intubation was performed using a fiberoptic device.…”

“…Currently, titanium stand-alone cages are commonly used in anterior cervical discectomy and fusion (ACDF). [ 1 2 3 4 5 6 7 ] ACDF using a rectangular titanium stand-alone cage has been shown to be technically easy, safe, and effective. Cervical intervertebral disc replacement using a titanium stand-alone cage can restore physiologic disc height and provide immediate load-bearing support to the anterior column, and it may promote arthrodesis.…”

Calcium-phosphate ceramics in spine surgery: features of regeneration and use

“…Також проведено порівняльний аналіз дослідження титанових кейджів з різними наповнювачами - ГА (72 сегменти, 48 пацієнтів) або β-ТКФ (93 сегменти, 57 пацієнтів). Авторами не виявлено вірогідних відмінностей у рухливості остистого відростка при згинанні й розгинанні (менше за 3 мм), були присутні кісткові перемички між тілами хребців і зони лізису навколо титанового каркасу [45].…”