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Cabrera JP, Muthu S, Mesregah MK, Rodrigues-Pinto R, Agarwal N, Arun-Kumar V, Wu Y, Vadalà G, Martin C, Wang JC, Meisel HJ, Buser Z. Complications With Demineralized Bone Matrix, Hydroxyapatite and Beta-Tricalcium Phosphate in Single and Two-Level Anterior Cervical Discectomy and Fusion Surgery. Global Spine J 2024; 14:78S-85S. [PMID: 38421333 PMCID: PMC10913904 DOI: 10.1177/21925682231157320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVES To analyze the evidence available reporting complications in single or two-level anterior cervical discectomy and fusion (ACDF) using a demineralized bone matrix (DBM), hydroxyapatite (HA), or beta-tricalcium phosphate (β-TCP). METHODS A systematic review of the literature using PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases was performed in August 2020 to identify studies reporting complications in one or two-level ACDF surgery using DBM, HA, or β-TCP. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. RESULTS A total of 1857 patients were included, 981 male and 876 female, across 17 articles; 5 prospective, and 12 retrospectives. We noted heterogeneity among the included studies concerning the study design and combination of graft materials utilized in them. However, we noted a higher incidence of adjacent segment disease (17.7%) and pseudoarthrosis (9.3%) in fusion constructs using DBM. Studies using β-TCP reported a higher incidence of pseudoarthrosis (28.2%) and implant failures (17.9%). CONCLUSIONS Degenerative cervical conditions treated with one or two-level ACDF surgery using DBM, HA, or β-TCP with or without cervical plating are associated with complications such as adjacent segment disease, dysphagia, and pseudarthrosis. However, consequent to the study designs and clinical heterogeneity of the studies, it is not possible to correlate these complications accurately with any specific graft material employed. Further well-designed prospective studies are needed to correctly know the related morbidity of each graft used for achieving fusion in ACDF.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
- Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, India
- Orthopaedic Research Group, Coimbatore, India
| | - Mohamed Kamal Mesregah
- Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt
| | - Ricardo Rodrigues-Pinto
- Spinal Unit/Unidade Vertebro-Medular (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Neha Agarwal
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | | | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Gianluca Vadalà
- Campus Bio-Medico University of Rome and Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Christopher Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey C Wang
- USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hans Jörg Meisel
- Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany
| | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA
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Fang L, Shen Z, Wang S, Kuang Y. Revision surgery of an older patient with adjacent segment disease (ASD) following anterior cervical discectomy and fusion by PCB: A case report. Interdisciplinary Neurosurgery 2021; 23:100944. [DOI: 10.1016/j.inat.2020.100944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Qian L, Jiang C, Sun P, Xu D, Wang Y, Fu M, Zhong S, Ouyang J. A comparison of the biomechanical stability of pedicle-lengthening screws and traditional pedicle screws: an in vitro instant and fatigue-resistant pull-out test. Bone Joint J 2018; 100-B:516-521. [PMID: 29629595 DOI: 10.1302/0301-620x.100b4.bjj-2017-0877.r1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to compare the peak pull-out force (PPF) of pedicle-lengthening screws (PLS) and traditional pedicle screws (TPS) using instant and cyclic fatigue testing. Materials and Methods A total of 60 lumbar vertebrae were divided into six groups: PLS submitted to instant pull-out and fatigue-resistance testing (groups A1 and A2, respectively), TPS submitted to instant pull-out and fatigue-resistance testing (groups B1 and B2, respectively) and PLS augmented with 2 ml polymethylmethacrylate, submitted to instant pull-out and fatigue-resistance testing (groups C1 and C2, respectively). The PPF and normalized PPF (PPFn) for bone mineral density (BMD) were compared within and between all groups. Results In all groups, BMD was significantly correlated with PPF (r = 0.83, p < 0.001). The PPFn in A1 was significantly less than in B1 (p = 0.006) and C1 (p = 0.002). The PPFn of A2 was significantly less than in B2 (p < 0.001) and C2 (p < 0.001). The PPFn in A1, B1, and C1 was significantly greater than in A2 (p = 0.002), B2 (p = 0.027), and C2 (p = 0.003). There were no significant differences in PPFn between B1 and C1, or between B2 and C2. Conclusion Pedicle lengthening screws with cement augmentation can provide the same fixation stability as traditional pedicle screws and may be a viable clinical option. Cite this article: Bone Joint J 2018;100-B:516-21.
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Affiliation(s)
- L Qian
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Shenzhen Digital Orthopedic Engineering Laboratory, Guangdong, 510515, China
| | - C Jiang
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Shenzhen Digital Orthopedic Engineering Laboratory, Guangdong, 510515, China
| | - P Sun
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Shenzhen Digital Orthopedic Engineering Laboratory, Guangdong, 510515, China
| | - D Xu
- Department of Orthopedics, Nanfang Hospital, Southern Medical University
| | - Y Wang
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Shenzhen Digital Orthopedic Engineering Laboratory, Guangdong, 510515, China
| | - M Fu
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Shenzhen Digital Orthopedic Engineering Laboratory, Guangdong, 510515, China
| | - S Zhong
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Shenzhen Digital Orthopedic Engineering Laboratory, Guangdong, 510515, China
| | - J Ouyang
- Department of Anatomy, Southern Medical University, Guangdong Provincial Key Laboratory of Medical Biomechanics, Shenzhen Digital Orthopedic Engineering Laboratory, Satai Road, Guangzhou, P.R.C, China, Guangzhou, China
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Noordhoek I, Koning MT, Jacobs WCH, Vleggeert-Lankamp CLA. Incidence and clinical relevance of cage subsidence in anterior cervical discectomy and fusion: a systematic review. Acta Neurochir (Wien) 2018; 160:873-880. [PMID: 29468440 PMCID: PMC5859059 DOI: 10.1007/s00701-018-3490-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
Background The placement of intervertebral cages in anterior cervical discectomy (ACDF) supposedly maintains foraminal height. The most commonly reported cage-related complication is subsidence, although it is unknown whether a correlation between subsidence and clinical outcome exists. Aim To assess the incidence and relevance of subsidence. Methods Literature searches were performed in PubMed, MEDLINE, Embase, Web of Science, COCHRANE, and CENTRAL. The inclusion criteria were as follows: ≥ 20 patients, ADCF with cage, subsidence assessed, and primary data. Risk of bias was assessed using adjusted Cochrane checklists. Results Seventy-one studies, comprising 4784 patients, were included. Subsidence was generally defined as ≥ 3-mm loss of height comparing postoperative intervertebral heights with heights at last follow-up. Mean incidence of subsidence was 21% (range 0–83%). Of all patients, 46% of patients received polyether-ether-ketone (PEEK) cages, 31% received titanium cages, 18% received cage-screw-combinations, and 5% received polymethyl-methacrylate (PMMA) cages. Patients treated with cage-screw-combinations had significantly less subsidence than patients treated with PEEK, titanium, or PMMA cages (15.1% vs. 23.5% vs. 24.9% vs. 30.2%; p < 0.001). Thirteen studies assessed clinical outcome in relation to subsidence; the majority did not find a significant correlation. Only four studies correlated subsidence to cage size and/or height; no correlation was established. Conclusions Subsidence in ACDF with cages occurs in 21% of patients. The risk for subsidence seems lower using PEEK or titanium cages or adding screws. Whether subsidence affects clinical outcome is not satisfactorily evaluated in the available literature. Future studies on this correlation are warranted in order to establish the additional value of the interposition of a cage in ACDF.
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Spallone A, Izzo C, Galassi S, Visocchi M. Is "mini-invasive" technique for iliac crest harvesting an alternative to cervical cage implant? An overview of a large personal experience. Surg Neurol Int 2013; 4:157. [PMID: 24381800 PMCID: PMC3872648 DOI: 10.4103/2152-7806.123202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/10/2013] [Indexed: 11/21/2022] Open
Abstract
Background: Autograft bone provides an excellent substrate for multilevel arthrodesis after anterior discectomy and is inexpensive. However, the use of tricortical bone could increase the discomfort for the patient. Methods: We reviewed cases of cervical disc diseases operated on by a single neurosurgeon (AS), within the period June 2000-December 2011. A total of 221 patients were considered for the present study; 109 female, 112 male, averaging 49 years of age. Only patients who could be followed up for at least one year were included in the present study. The grafts obtained with the technique described are bi- (and not tri-) cortical, and always of sufficient size in order to fit two spaces if necessary. Results: The technique is not associated with long-term significant donor site pain except for a striking minority of patients, it shortens the hospital stay, it offers comparable results to the published surgical series in which cage and/or modern implants are used. Conclusions: Autograft bone can be reasonably considered as one of the possible alternatives to be used in the surgical management of cervical disk disease.
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Affiliation(s)
- Aldo Spallone
- Section of Neurosurgery, Department of Clinical Neurosciences, N.C.L. Neurological Center of Latium, Italy ; Department of Biopathology, Institute of Anatomical Pathology, Tor Vergata University of Rome, Italy
| | - Chiara Izzo
- Section of Neurosurgery, Department of Clinical Neurosciences, N.C.L. Neurological Center of Latium, Italy
| | - Stefania Galassi
- Ospedale Pediatrico Bambino Gesù, IRCCS, Department of Diagnostic Imaging, Unit of Neuroradiology, Italy
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Gu Y, Yang HL, Chen L, Dong RB, Han GS, Wu GZ, Chen KW, Tang TS. Use of an integrated anterior cervical plate and cage device (PCB) in cervical anterior fusion. J Clin Neurosci 2009; 16:1443-8. [PMID: 19683929 DOI: 10.1016/j.jocn.2009.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Revised: 01/20/2009] [Accepted: 02/03/2009] [Indexed: 11/29/2022]
Abstract
The aim of this study is to evaluate an integrated cage and plate device (the plate cage Benezech, PCB) filled with autogenous bone in anterior cervical discectomy and fusion. The fused segment height, lordosis, and fusion were assessed by postoperative radiographic examination at different intervals. Patients were evaluated using Odom's criteria and the Short Form (SF)-36 Health Survey questionnaire. The mean follow-up duration was 4.1 years. Fusion was achieved in 90.0%, 96.0% and 100% of patients at 3 months, 6 months and at final visit, respectively. The fused segment height and lordosis were restored and maintained. Cage subsidence (3mm) occurred at one level and settling was observed at three levels. An excellent-to-good result was achieved in 81.8% of patients. The data from the SF-36 questionnaire revealed significant postoperative improvement (p<0.01) except for social function and mental health. This study suggests that patients instrumented with PCB can obtain good radiographic and clinical results and that PCB is a safe and effective device in cervical anterior fusion.
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Affiliation(s)
- Yong Gu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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