Anterior Cervical Discectomy With Freeze-Dried Fibula Allograft

Martin, George J.; Haid, Regis W.; MacMillan, Michael; Rodts, Gerald E.; Berkman, Richard

doi:10.1097/00007632-199905010-00004

Cited by 183 publications

(124 citation statements)

References 26 publications

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“…[45][46][47][48] The loss of the construct height will result in loss of sagittal balance and can potentially alter the biomechanics of the adjacent level. The importance of this sagittal balance on the rate of adjacent level degeneration has been demonstrated in the lumbar spine.…”

Section: Discussionmentioning

confidence: 99%

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Ordway

Rim²,

Tan

et al. 2011

Journal Orthopaedic Research

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Graft subsidence following anterior cervical reconstruction can result in the loss of sagittal balance and recurring foraminal stenosis. This study examined the implant-endplate interface using a cyclic fatigue loading protocol in an attempt to model the subsidence seen in vivo. The superior endplate from 30 cervical vertebrae (C3 to T1) were harvested and biomechanically tested in axial compression with one of three implants: Fibular allograft; titanium mesh cage packed with cancellous chips; and trabecular metal. Each construct was cyclically loaded from 50 to 250 N for 10,000 cycles. Nondestructive cyclic loading of the cervical endplate-implant construct resulted in a stiffer construct independent of the type of the interbody implant tested. The trabecular metal construct demonstrated significantly more axial stability and significantly less subsidence in comparison to the titanium mesh construct. Although the allograft construct resulted in more subsidence than the trabecular metal construct, the difference was not significant and no difference was found when comparing axial stability. For all constructs, the majority of the subsidence during the cyclic testing occurred during the first 500 cycles and was followed by a more gradual settling in the remaining 9,500 cycles. Keywords: cervical endplate; fatigue; cyclic testing; biomechanics; subsidence Anterior cervical fusion has traditionally been a predictable and reliable surgical technique for treatment of multiple spinal pathologies. [1][2][3] The success has been due to factors that are addressed by the surgical procedure: the removal of the pathologic process; the decompression of the neural elements; the correction of sagittal balance; and the stabilization of the motion segment. Maintenance of sagittal balance and continued stabilization of the motion segment following anterior reconstruction is essential in obtaining a successful clinical outcome. Subsidence of an interbody graft or construct prior to bony fusion can be detrimental to sagittal balance and/or stabilization of the motion segment resulting in recurrent foraminal stenosis.Options available for reconstructing the anterior cervical column include a structural autograft, a structural allograft, a carbon fiber cage, a PEEK cage, a titanium mesh cage, or a trabecular metal spacer. Material properties and interface geometries vary, but the devices function similarly by providing mechanical integrity and stability to the construct while bony fusion takes place. Independent of the device, settling occurs following anterior interbody fusion, 4-6 the amount of which is affected by intraoperative endplate injury or removal, osteoporosis, and the cross-sectional area of the implant. 7,8 Obtaining contact between the endplate and implant surfaces is technically challenging, and a certain amount of settling occurs early post-operatively. With bony implants, additional settling occurs as the graft is resorbed prior to bone fusion. The amount of settling is often <1 mm. Other causes of post-op...

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Section: Discussionmentioning

confidence: 99%

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Ordway

Rim²,

Tan

et al. 2011

Journal Orthopaedic Research

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“…Both reports of cervical cage trials [4,16] deal with preliminary results; long-term results have not yet been reported. However, experience suggests long-term complications in the use of cervical cages, such as subsidence of the cages into the adjacent vertebrae or bone resorption within the cages [7,10,12,15]. Bone resorption and substitution by soft tissue may be caused by insufficient stability [21] or by inadequate loading of the bone within the cages.…”

Section: Discussionmentioning

confidence: 99%

“…Bone graft [6,28] or bone cement [8,25] are counted among these intervertebral spacers. However, complications like graft expulsion, non-union or bone graft collapse have been reported [5,7,14,15,31].…”

Section: Introductionmentioning

confidence: 99%

Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement

Wilke¹,

Kettler²,

Claes³

2000

European Spine Journal

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“…1 The incidence of pseudarthrosis after an anterior cervical approach is used is dependent on the number of levels involved and ranges from 0 to 50%. 2,6,13,15,17,18,20 Despite the widespread application of anterior plates, clinicians have not been able to eliminate the development of pseudarthrosis. 11,24,25 Complaints associated with a cervical nonunion include persistent or recurrent axial neck pain, radiculopathy, and myelopathy.…”

Section: Rationalementioning

confidence: 99%

Management of anterior cervical pseudarthrosis

Kaiser

Mummaneni

Matz

et al. 2009

SPI

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Object The objective of this systematic review was to use evidence-based medicine to identify the best methodology for diagnosis and treatment of anterior pseudarthrosis. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to pseudarthrosis and cervical spine surgery. Abstracts were reviewed, after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Evaluation for pseudarthrosis is warranted, as there may be an association between clinical outcome and pseudarthrosis. The strength of this association cannot be accurately determined because of the variable incidence of symptomatic and asymptomatic pseudarthroses (Class III). Revision of a symptomatic pseudarthrosis may be considered because arthrodesis is associated with improved clinical outcome (Class III). Both posterior and anterior approaches have proven successful for surgical correction of an anterior pseudarthrosis. Posterior approaches may be associated with higher fusion rates following repair of an anterior pseudarthrosis (Class III). Conclusions If suspected, pseudarthrosis should be investigated because there may be an association between arthrodesis and outcome. However, the strength of this association cannot be accurately determined. Anterior and posterior approaches have been successful.

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Anterior Cervical Discectomy With Freeze-Dried Fibula Allograft

Cited by 183 publications

References 26 publications

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate

Primary stabilizing effect of interbody fusion devices for the cervical spine: an in vitro comparison between three different cage types and bone cement

Management of anterior cervical pseudarthrosis

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