Anterior cervical fusion with interbody cage containing β-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up

Dai, Li-Yang; Jiang, Lei‐Sheng

doi:10.1007/s00586-008-0643-8

Cited by 78 publications

(75 citation statements)

References 27 publications

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“…None of the patients had severe disability with a score [50%. The NDI average improvement rate is 65%, which is similar to literature data [4,8,10,11,13,19,24,29,33]. Radiographic outcome demonstrates correction of the kyphotic deformation with improvement of the lordotic overall and segmental alignment after surgery (except one patient with a smaller cage).…”

Section: Discussionsupporting

confidence: 86%

Anterior cervical fusion with a bio-resorbable composite cage (beta TCP–PLLA): clinical and radiological results from a prospective study on 20 patients

et al. 2009

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A resorbable composite material (40% PLLA and 60% beta TCP) with a high breaking strength and capacity to withstand plastic and elastic strain has been developed for cervical interbody fusion. This is a prospective study to evaluate clinical and radiological results of 20 patients implanted with 27 cages (mean follow-up, 27 months). Clinical (neck disability index, VAS, neurological evaluation) and radiological (anteroposterior, lateral, bending X-rays) data were assessed before and after surgery. At the end of the study, CT scan was performed to evaluate fusion, resorption of the cage and density of the new tissue substituting the cage. The mean patient age was 50.3 years (range, 18-79 years). The average improvement was 55% for neck pain, 83% for arm pain and 65% for NDI, with 85% good or excellent results at final outcomes. Radiologically, lordosis was significantly improved (mean gain of 5.4°and 3.7°for overall and segmental lordosis, respectively). This correction was conserved in 95% of cases. Fusion was obtained in 96% (CT evaluation). Resorption was started in all cases and completed in an average of 36 months after surgery. The mean density of tissue substituting the cage was 659 UH with a range, of 455-911 UH (compatible with bone nature). Over time, the amount of bony tissue increased and the graft remodelled with an increase in density value. This demonstrates a biological activity and changing bone mineral content of this tissue. The new composite cage under investigation provides long-term fusion without loss of correction or inflammatory reaction. The ceramic block guarantees the maintenance of the disc height and its slow resorption allows long-term fusion and stability with good and reliable clinical and radiological outcomes.

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Section: Discussionsupporting

confidence: 86%

Anterior cervical fusion with a bio-resorbable composite cage (beta TCP–PLLA): clinical and radiological results from a prospective study on 20 patients

et al. 2009

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“…They found that good neurological outcome was achieved in both groups, while the patients treated with stand-alone cage have lower complication rate and shorter hospital stay. In a prospective randomized study, Dai et al [5] used carbon fiber or PEEK cages containing b-tricalcium phosphate in anterior cervical fusion and found that supplement with anterior plate fixation can increase the fusion rate and prevent cage subsidence but did not improve the 2-year outcome. In the current study, high fusion rate and good clinical outcome of stand-alone cage Fig.…”

Section: Discussionmentioning

confidence: 99%

Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study

et al. 2011

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Objective Clinical outcomes of the stand-alone cage have been encouraging when used in anterior cervical discectomy and fusion (ACDF), but concerns remain regarding its complications, especially cage subsidence. This retrospective study was undertaken to investigate the long-term radiological and clinical outcomes of the stand-alone titanium cage and to evaluate the incidence of cage subsidence in relation to the clinical outcome in the surgical treatment of degenerative cervical disc disease. Methods A total of 57 consecutive patients (68 levels) who underwent ACDF using a titanium box cage for the treatment of cervical radiculopathy and/or myelopathy were reviewed for the radiological and clinical outcomes. They were followed for at least 5 years. Radiographs were obtained before and after surgery, 3 months postoperatively, and at the final follow-up to determine the presence of fusion and cage subsidence. The Cobb angle of C2-C7 and the vertebral bodies adjacent to the treated disc were measured to evaluate the cervical sagittal alignment and local lordosis. The disc height was measured as well. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score for cervical myelopathy, before and after surgery, and at the final follow-up.The recovery rate of JOA score was also calculated. The Visual Analogue Scale (VAS) score of neck and radicular pain were evaluated as well. The fusion rate was 95.6% (65/68) 3 months after surgery. ResultsSuccessful bone fusion was achieved in all patients at the final follow-up. Cage subsidence occurred in 13 cages (19.1%) at 3-month follow-up; however, there was no relation between fusion and cage subsidence. Cervical and local lordosis improved after surgery, with the improvement preserved at the final follow-up. The preoperative disc height of both subsidence and non-subsidence patients was similar; however, postoperative posterior disc height (PDH) of subsidence group was significantly greater than of non-subsidence group. Significant improvement of the JOA score was noted immediately after surgery and at the final follow-up. There was no significant difference of the recovery rate of JOA score between subsidence and non-subsidence groups. The recovery rate of JOA score was significantly related to the improvement of the C2-C7 Cobb angle. The VAS score regarding neck and radicular pain was significantly improved after surgery and at the final follow-up. There was no significant difference of the neck and radicular pain between both subsidence and non-subsidence groups. ConclusionsThe results suggest that the clinical and radiological outcomes of the stand-alone titanium box cage for the surgical treatment of one-or two-level degenerative cervical disc disease are satisfactory. Cage subsidence does not exert significant impact upon the long-term clinical outcome although it is common for the stand-alone cages. The cervical lordosis may be more important for the longterm clinical outcome than cage subsidence

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“…Dai and Jiang recently published the only clinical controlled trial of b-TCP, contained in interbody cages, for patients with cervical radiculopathy or myelopathy [27]. A total of 62 patients were randomized into an anterior plating or non-plating treatment group, and followed for 2 years.…”

Section: Beta-tricalcium Phosphatementioning

confidence: 99%

Bone graft substitutes in anterior cervical discectomy and fusion

2009

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Anterior cervical discectomy with fusion is a common surgical procedure for patients suffering pain and/ or neurological deficits and unresponsive to conservative management. For decades, autologous bone grafted from the iliac crest has been used as a substrate for cervical arthrodesis. However patient dissatisfaction with donor site morbidity has led to the search for alternative techniques. We present a literature review examining the progress of available grafting options as assessed in human clinical trials, considering allograft-based, synthetic, factor-and cell-based technologies.

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Anterior cervical fusion with interbody cage containing β-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up

Cited by 78 publications

References 27 publications

Anterior cervical fusion with a bio-resorbable composite cage (beta TCP–PLLA): clinical and radiological results from a prospective study on 20 patients

Anterior cervical fusion with a bio-resorbable composite cage (beta TCP–PLLA): clinical and radiological results from a prospective study on 20 patients

Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study

Bone graft substitutes in anterior cervical discectomy and fusion

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