Donor Site Morbidity After Anterior Iliac Crest Bone Harvest for Single-Level Anterior Cervical Discectomy and Fusion

Silber, Jeff S.; Anderson, D. Greg; Daffner, Scott D.; Brislin, Brian T.; Leland, J. Martin; Hilibrand, Alan S.; Vaccaro, Alexander R.; Albert, Todd J.

doi:10.1097/00007632-200301150-00008

Cited by 802 publications

(528 citation statements)

References 18 publications

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“…of the donor site in 10% of cases and major complications in 5.8% of cases, requiring therapeutic modifications, surgical revision, and prolongation of the duration of hospitalization. Silber et al [22] observed that 26.1% of patients reported pain of the donor site, with visual analog scale values between 3.8 and 10 on a scale of 10. The use of vertebral cages responds to biomechanical imperatives and, by use of bone harvested in situ during the corpectomy, avoids complications involving the bone harvest.…”

Section: Discussionmentioning

confidence: 99%

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Radiolucent cage for cervical vertebral reconstruction: A prospective study of 17 cases with 2-year minimum follow-up

et al. 2004

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Section: Discussionmentioning

confidence: 99%

“…However, morbidity involving the site of graft harvest remains high and can compromise the often satisfactory clinical result of cervical nerve root and spinal cord decompression [3,22].…”

Section: Introductionmentioning

confidence: 99%

Radiolucent cage for cervical vertebral reconstruction: A prospective study of 17 cases with 2-year minimum follow-up

et al. 2004

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“…Silber et al [86] noticed serious impairments in functional activities of daily living in about 10% of patients due to the iliac crest site and mean VAS was 3.8 at 4 years follow-up. In contrast, Shamsaldin et al [84] demonstrated that after harvesting bone from the iliac crest for 1-level ACDF, 92% had no persisting pain after 1 year.…”

Section: Complicationsmentioning

confidence: 99%

“…Graft donor site pain and morbidity is a liberally used criticism of using autograft [86]. Silber et al [86] noticed serious impairments in functional activities of daily living in about 10% of patients due to the iliac crest site and mean VAS was 3.8 at 4 years follow-up.…”

Section: Complicationsmentioning

confidence: 99%

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

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“…Although there is still controversy about the necessity of fusion after anterior cervical discectomy [25], most authors agree that fusion stabilizes the cervical spine and maintains the disc height, while decompressing the spinal cord and roots [1,30]. However, autogenous tricotical iliac bone, which is widely used in ACDF as interbody graft, is associated with donorsite morbidity as well as graft problems [23,27].…”

Section: Introductionmentioning

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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Donor Site Morbidity After Anterior Iliac Crest Bone Harvest for Single-Level Anterior Cervical Discectomy and Fusion

Cited by 802 publications

References 18 publications

Radiolucent cage for cervical vertebral reconstruction: A prospective study of 17 cases with 2-year minimum follow-up

Radiolucent cage for cervical vertebral reconstruction: A prospective study of 17 cases with 2-year minimum follow-up

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

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

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