Morphological adaptation of the bone graft and fused bodies after non-instrumented anterior interbody fusion of the lower cervical spine

PURPOSE

To assess the remodelling process of the bone graft and fused bodies after non-instrumented anterior interbody fusion with autogenous iliac graft in patients with spondylosis, infections, fractures, or disorders of the cervical spine.

METHODS

68 patients aged 18 to 58 years who underwent non-plated anterior lower cervical interbody fusion with an iliac graft were retrospectively studied. Diagnoses of the patients were degenerative disc diseases (n=32), disc herniation (n=15), fractures (n=13), and tuberculosis (n=8). The Robinson and Smith technique was used to treat degenerative disc diseases and protruded disc, and the Bailey and Badgley procedure for fractures or tuberculosis of the cervical spine. 34, 25, and 9 patients underwent one-, 2-, and 3-segment fusions, respectively. 18 of the 25 patients underwent two-segment fusion with a single large bone block, and 7 with 2 separate bone blocks for each segment. Four of the 9 patients underwent three-segment fusion with a single large bone block, and 5 used separate grafts for each segment independently. Plain and stress radiography was primarily used to assess the fusion. Computed tomography and magnetic resonance imaging were also used in some patients. Some anterior graft extrusion (amounting to less than 10% of corresponding anteroposterior body width) was used to observe the remodelling during graft-take and thereafter. Postoperative cervical traction for 2 to 4 weeks, then cervical collar immobilisation for 4 to 12 weeks were strictly followed according to the numbers of fused segments. A halo vest was applied in 4 patients with fracture undergoing 3-segment fusion as they could not tolerate the prolonged bed rest or rigid cervical brace.

RESULTS

The mean time for the graft to fuse was 8.6 (range, 7-14) weeks in patients who underwent each segment fusion with independent free grafts, and 10 and 14 weeks in those who underwent 2- and 3-segment single large graft fusion, respectively. The final loss of disc height and joint angle were negligible, regardless of the extent of fusion. Bony absorption of the anteriorly protruded part of the graft began at postoperative week 10 (range, 6-28), which coincided with the time of graft-take and initiation of remodelling.

CONCLUSION

The earliest sign of bony absorption of the anteriorly protruded part of the graft indicated the initiation of the graft-take and the graft remodelling. The inwaisting sign of the surgically fused block of vertebral bodies was a morphological adaptation. Despite the altered biomechanics of the spine in the fused area, the inwaisting sign indicated maintenance of normal function at the parafusion motion segments.

A preliminary study of the use of cage and plating for single-segment fusion in degenerative cervical spine disease

Three different surgical methods were used to treat single-segment degenerative cervical spine disease, and the radiological and clinical outcomes were compared. The three groups compared were: 21 cases of anterior interbody fusion with iliac autograft (group A); 20 cases of anterior plate fixation with iliac autograft (group B); and 19 cases of carbon cage fusion and anterior plate fixation (group C). Bone union and changes in Cobb's angle and interbody space were evaluated using radiographs and clinical results by the method of Odom et al. Cobb's angle increased in group C, which was significantly better than the decrease in groups A and B. The interbody space decreased in group C, but was significantly less than the decrease in groups A and B. Carbon cage and anterior plate fixation can be used as an alternative surgical treatment modality for single-segment degenerative cervical spine and can provide early stability, maintain the interbody space and cervical lordosis, reduce operation time and minimize complications at the bone graft donor site.