Use of Patella Allograft for Anterior Cervical Diskectomy and Fusion

ArticleinJournal of spinal disorders & techniques 22(6):392-8 · September 2009with16 Reads
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.
    • "Because the PCF is commonly used to treat cervical radiculopathy and may confer certain advantages over ACDF, it is important to understand the clinical outcomes and the reoperation rate after PCF. In the present study, 9 (5%) patients underwent reoperation after a PCF surgery; this rate is similar to the reoperation rates found in the literature for ACDF [11,[14][15][16][17][18]. Ruetten et al. performed a retrospective review of 103 patients who underwent ACDF and found a revision rate of 6.1%, respectively [28]. "
    [Show abstract] [Hide abstract] ABSTRACT: In select patients, posterior cervical foraminotomy (PCF) and anterior cervical discectomy and fusion (ACDF) result in similar clinical outcomes when used to treat cervical radiculopathy. Nonetheless, ACDF is performed more frequently, in part because of surgeon perception that PCF requires operative revisions more frequently. The present study investigates the rate of ACDF reoperation at the index level after initial PCF. To determine the rate of ACDF after initial PCF and to further describe any patient characteristics or preoperative or operative data that increase the rate of reoperation after PCF. Retrospective chart review. Demographic, operative, and reoperation information was collected from the electronic medical records for all patients who underwent PCF at one institution between 2004 and 2011. All patients were subsequently contacted by telephone to identify postoperative complications and more conclusively determine whether any revision operation was performed at the index level. One hundred seventy-eight patients who underwent a PCF were reviewed, with an average follow-up of 31.7 months. Nine (5%) patients underwent an ACDF revision operation at the index level. The reason for reoperation in these patients included cervical radiculopathy, foraminal stenosis, disc herniation, and cervical spondylosis. Patients who subsequently underwent ACDF at the index level were significantly younger (25 vs. 35 years, p=.03), had lower body mass index (25 vs. 29, p=.01), and more likely to take anxiolytic (56% vs. 22%, p=.04) or antidepressant medication (67% vs. 27%, p=.02), compared with those that did not have a revision operation. This is the first study to determine conversion to ACDF after PCF. The present study demonstrates that PCF is associated with a low reoperation rate, similar to the historical reoperation for ACDF. Accordingly, spine surgeons can operate via a PCF approach without a significant increased risk for ACDF revision surgery at the index level.
    Full-text · Article · Jul 2013
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    Conference Paper · Jan 2004 · Journal of Clinical Rehabilitative Tissue Engineering Research
  • [Show abstract] [Hide abstract] ABSTRACT: BACKGROUND: Many scholars adopt allograft interbody fusion for vertebral body resection and reconstruction, bone fusion time is better than autologous bone graft's, and its integration provides an early support and stabilizing, but the preparation of allogeneic bone graft material is easy to destroy bone-inducing factor in matrix, which is not conducive to bone growth. OBJECTIVE: To innovatively design and verify the ability of reconstructing rabbit cervical vertebrae with the compound of humeral cortical ring allograft (HCA) packed with red bone marrow (RBM) and autogenous cancellous bone (ACB). DESIGN, TIME AND SETTING: Randomized controlled animal experiment was performed at the laboratory of Orthopedic Department in Renmin Hospital of Wuhan University, between October 2004 and March 2006. MATERIALS: Sixty healthy adult New Zealand white rabbits, of either sex, body mass of 2.0-2.5 kg, were involved in this study. Twelve rabbits were used for HCA preparation, while the remaining 48 rabbits were randomly divided into 3 groups with sixteen rats in each group. Autologous RBM was extracted from the anterior superior iliac spine through puncture; ACB was obtained from tri-cortical bone of rabbit iliac crest. Autologous RBM and ACB were compounded and filled in the self-made HCA. METHODS: Models of the fourth cervical vertebrae defect were created by surgery to simulate tumor resection in New Zealand white rabbits, which were divided into 3 groups randomly. Combined transplant group was treated with the compound of RBM+ACB+HCA; autologous bone transplant group with autogenous iliac crest; HCA transplant group with HCA. MAIN OUTCOME MEASURES: Vertebral reconstructions were evaluated by X-ray, histopathological observation and scanning electron microscope, as well as measurement of serum alkaline phosphates at different periods postoperatively. RESULTS: Eight weeks post-surgery, graft materials fused with the upper and lower cervical fusion, a large number of bone callus were observed in combined transplant group and autologous bone transplant group; HCA transplant group was present with a small amount of callus growth and poor fusion. Serum alkaline phosphatase levels were elevated in all groups, significantly higher in combined transplant group and autologous bone transplant group compared with HCA transplant group (P < 0.01). There were no significant differences of serum alkaline phosphatase levels between combined transplant group and autologous bone transplant group at 4 weeks or among 3 groups 8 weeks (P > 0.05). Histological analysis exhibited numerous mature bone matrix, bone trabecula and bone marrow cavity formed in combined transplant group and autologous bone transplant group. Scanning electron microscopy showed that many new bone formations in combined transplant group and autologous bone transplant group. CONCLUSION: The compound of RBM+ACB+HCA and autogenous iliac crest transplantation can efficiently reconstruct cervical vertebrae, RBM+ACB can improve the reconstruction efficiency of HCA, and could use as a material in cervical reconstruction.
    Article · Dec 2009
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