Use of Patella Allograft for Anterior Cervical Diskectomy and Fusion

Department of Orthopaedic Surgery and Rehabilitation, University of Wisconsin, Madison, WI 53792, USA.
Journal of spinal disorders & techniques (Impact Factor: 1.89). 09/2009; 22(6):392-8. DOI: 10.1097/BSD.0b013e3181844d8e
Source: PubMed

ABSTRACT Retrospective cohort.
The purpose of this study is to determine the fusion rates of a consecutive series of anterior cervical decompressions and fusions with allograft patella using both static and dynamic plates.
Anterior cervical diskectomy and fusion (ACDF) has been shown to improve symptoms of radiculopathy and myelopathy. The gold standard for obtaining fusion is using autogenous iliac crest bone graft (ICBG). The complication rate of using ICBG can be as high as 20%. To minimize this morbidity, various forms of allograft are presently used. We have used patellar allograft that we hypothesize exhibits a good combination of strength and sufficient porosity to facilitate fusion.
A consecutive series of 179 levels in 136 patients who underwent single and multilevel ACDF with allograft patella were retrospectively investigated. Final follow-up lateral cervical spine radiographs were evaluated for evidence of bony fusion. Fusions were graded independently by 2 of the investigators according to an interbody fusion classification proposed by Bridwell and colleagues, Spine, 1995. Fusion rates were compared with historical controls for single-level ACDF with autogenous ICBG and plating. Multivariate analysis was used to evaluate plate type, smoking, revision rate, and Odom's criteria compared with fusion.
Ninety-one consecutive single and 81 multilevel anterior cervical decompression and fusions with allograft patella were reviewed. Demographics were similar (average age 47.75 y). Average follow-up was 19.3 months. Fusion rates were 86% (159/179). Our revision rate was 8%. Eighty-one percent (85/98) union rate was noted in the single-level group, and 85% (69/81 levels) or 74% (28/38 patients) in the multilevel group.
Fusion rates were 86%. Plate design (static vs. dynamic) did not seem to affect fusion rates or clinical outcomes. There was a higher nonunion rate at the most inferior level of the multilevel fusions. Nonunions in the dynamic group were more commonly revised and had more kyphosis at final follow-up.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Multiband keying (MBK) has been proposed as a means of modulating information bits into ultra wideband signals. In this paper, we are concerned with multiband keying modulation employing MPSK signals in each subband. The optimal receiver for the MBK symbols over an AWGN channel and the corresponding maximum likelihood (ML) decision rule have been presented and its performance is evaluated through analysis and simulation. An efficient algorithm, based on a depth-first tree search, is also introduced in order to simplify the maximum likelihood detection. It is shown by simulation that while the proposed algorithm significantly reduced the computational complexity, the performance in terms of symbol error rate is very close to that of the optimal ML receiver.
    Global Telecommunications Conference, 2004. GLOBECOM '04. IEEE; 01/2004
  • [Show abstract] [Hide abstract]
    ABSTRACT: A variety of donor-site complications have been reported for anterior cervical discectomy and fusion (ACDF) using autologous iliac bone graft. To minimize such morbidities and to obtain optimal bony fusion at the ACDF surgery, a novel technique was used to harvest cancellous bone from the autologous clavicle instead of the popular iliac crest graft. After a routine cervical discectomy of the affected level, a 1.5-cm linear skin incision was made over the clavicle within 2.5 cm of the sternoclavicular joint on the medial one-third portion. This portion is known as an anatomically safe zone, with no subcutaneous distribution of the supraclavicular nerve. Then, cancellous bone was harvested through a small cortical window developed on the clavicle. Care was taken not to injure the subclavian major vessels and the lung below the clavicle. A box-type titanium cage was packed with the harvested cancellous bone and then inserted into the discectomy-treated space for cervical interbody fusion. From 2009 to 2013, 16 patients with cervical radiculopathy and/or myelopathy underwent single-level ACDF with this method. All but 1 patient experienced significant improvement of clinical symptoms after the surgery and showed radiographic evidence of solid bony fusion and spinal stabilization within 6 months. Further, no peri- and postoperative complications at the clavicular donor site were noted. The mean visual analog scale pain score (range 0 [no pain to 10 [maximum pain]) at 1 year after the surgery was 0.1, and 13 of 14 patients with data at 1-year follow-up were highly satisfied with their donor-site cosmetic outcome. The clavicle is a safe, reliable, and technically easy source of autologous bone graft that yields optimal fusion rates and patient satisfaction with ACDF surgery.
    Journal of Neurosurgery Spine 08/2014; 21(5):1-8. DOI:10.3171/2014.7.SPINE131000 · 2.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Anterior cervical discectomy and fusion (ACDF) procedures are increasingly being managed on an outpatient basis. Currently there are no definitive guidelines within the literature that delineate which patient population can safely be managed as such. The purpose of this study is to demonstrate that ACDF procedures, within a selective patient population at our institution, can be safely performed on an outpatient basis. This is a retrospective chart review within one physician's practice of patients undergoing instrumented ACDF procedures using allograft. This sample included 117 patients who underwent one- and two-level ACDF procedures from November 2005 to April 2009. Hospital length of stay and hospital readmissions were noted. Complication rates in the outpatient population were assessed to determine the feasibility of outpatient management for selective patients undergoing ACDF procedures. A total of 59 patients (50%) were treated on an outpatient basis. Sixty-eight patients underwent single level ACDF procedures, 38 patients (56%) of which were discharged on the same day. Forty-nine patients underwent two-level ACDF procedures, 21 patients (43%) of which were discharged on the same day. There was one complication (1.4%) in patients who were discharged on the same day. That patient required readmission for 23-hour observation secondary to neck swelling. ACDF procedures involving single and two-level fusions can safely be performed on an outpatient basis. Complication rates associated with this procedure are low, with critical postoperative complications involving respiratory compromise occurring very infrequently and in the immediate postoperative period.
    World Neurosurgery 01/2011; 75(1):145-8; discussion 43-4. DOI:10.1016/j.wneu.2010.09.015 · 2.42 Impact Factor