J Korean Orthop Assoc.  2008 Jun;43(3):338-346. 10.4055/jkoa.2008.43.3.338.

Anterior Cervical Fusion with Autogenous Iliac Bone Graft with or without Plate Fixation for Degenerative Cervical Spinal Disorders

• Song KJ
• Choi BW
• Kim KH
• Lee KB

• KMID: 2186450
• DOI: http://doi.org/10.4055/jkoa.2008.43.3.338

Abstract

PURPOSE: This study compared the results of anterior cervical discectomy and fusion with autogenous bone graft (AFA) with or without plate fixation through a retrospective review of one or two-level degenerative cervical disorder, and the average follow-up was 6 years.
MATERIALS AND METHODS
Group A (n=40) underwent one-level (A-1/26) or two-level (A-2/14) fusion and AFA alone. Group B (n=36) underwent one-level (B-1/24) or two-level (B-2/12) fusion and AFA with plate construct. The following parameters were analyzed: the fusion rate, the change of Cobb's angle, the adjacent level degeneration (ALD), the clinical outcome and the rate of complications.
RESULTS
There was a significant difference in the fusion rate between group A and B (p=0.028). Group B had a significant increase in the change of Cobb's angle compared to groups A (p=0.004). ALD were developed in 16 of 40 cases (40%) in group A, and in 4 of 36 cases (11%) in group B. There was a significant difference in ALD between group A and group B (p=0.004).
CONCLUSION
We think that plate augmentation is necessary for the maintenance of lordosis, for reducing the pseudarthrosis and adjacent level degeneration, and to improve the clinical outcome after treatment of degenerative cervical disorders.

Keyword

Degenerative cervical disorder; Anterior cervical fusion; Autogenous iliac bone graft; Plate Fixation

MeSH Terms

Animals
Diskectomy
Follow-Up Studies
Lordosis
Pseudarthrosis
Retrospective Studies
Transplants

Figure

• 

  Fig. 1 This forty six year-old female patient (case 57) with a cervical disc herniation at C5-6 underwent anterior cervical discectomy and fusion with an autogenous iliac tricortical bone graft, and plate fixation. (A) Preoperative lateral radiograph shows degenerative disc space narrowing at C5-6. (B) Postoperative lateral radiograph shows the bone graft with plate fixation on C5-6. (C) Lateral radiograph after 1 year shows solid bony fusion at C5-6. (D) Lateral radiograph after 3 years shows normal sagittal alignment and no visible degenerative changes at the adjacent segment.

• 

  Fig. 2 This thirty six year-old female patient (case 32) with a cervical myelopathy and disc herniation at C4-5 underwent anterior cervical discectomy and fusion with an autogenous iliac tricortical bone graft. (A) Preoperative lateral radiograph shows degenerative disc space narrowing at C4-5. (B) Postoperative lateral radiograph shows ACDF with bone graft only at C4-5. (C) Lateral radiograph after 2 years shows bone graft collapse with pseudoarthrosis at the distal end of the bone graft at C4-5, with progressive kyphosis. (D) Lateral radiograph after 8 years shows solid fusion at C4-5 with severe degenerative changes at C3-4 and local kyphosis.

Reference

1. Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine. 1995. 20:1055–1060.

2. Böhler J, Gaugermark T. Anterior plate stabilization for fracture-dislocation of the lower cervical spine. J Trauma. 1980. 20:203–205.

3. Bolesta MJ, Rechtine GR 2nd, Chrin AM. Three-and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine. 2000. 25:2045–2046.

4. Brantigan JW. Pseudarthrosis rate after allograft posterior lumbar interbody fusion with pedicle screw and plate fixation. Spine. 1994. 19:1271–1279.

5. Cloward RB. The anterior approach for removal of ruptured cervical disc. J Neurosurg. 1958. 15:602–617.

6. DePalma AF, Rothman RH, Lewinnek GE, Canale ST. Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet. 1972. 134:755–758.

7. Döhler JR, Kahn MR, Hughes SP. Instability of the cervical spine after anterior interbody fusion. A study on its incidence and clinical significance in 21 patients. Acte Orthop Trauma Surg. 1985. 104:247–250.

8. Emery SE, Fisher JR, Bohlman HH. Three-level anterior cervical discectomy and fusion: radiographic and clinical results. Spine. 1997. 22:2622–2624.

9. Gassman J, Seligson D. The anterior cervical plate. Spine. 1983. 8:700–707.

10. Gore DR, Sepic SB. Anterior discectomy and fusion for painful cervical disc disease. A report of 50 patients with an average follow-up of 21 years. Spine. 1993. 23:2047–2051.

11. Goto S, Mochizuki M, Kita T, et al. Anterior surgery in four consecutive technical phases for cervical spondylotic myelopathy. Spine. 1993. 18:1986–1973.

12. Hacker RJ, Cauthen JC, Gilbert TJ, et al. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine. 2000. 25:2646–2654.

13. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999. 81:519–528.

14. Hilibrand AS, Yoo JU, Carlson GD, Bohlman HH. The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine. 1997. 22:1574–1579.

15. Karasick D. Anterior cervical spine fusion: struts, plug, and plates. Skeletal Radiol. 1993. 22:85–94.

16. Kawakami M, Tamaki T, Iwasaki H, Yoshida M, Ando M, Yamada H. A comparative study of surgical approaches for cervical compressive myelopathy. Clin Orthop Relat Res. 2000. 381:129–136.

17. Lowery GL, McDonough RF. The significance of hardware failure in anterior cervical plate fixation: patients with 2-to 7-year follow-up. Spine. 1998. 23:181–187.

18. Malloy KM, Hilibrand AS. Autograft versus allograft in degenerative cervical disease. Clin Orthop Relat Res. 2002. 394:27–38.

19. Oda I, Cunningham BW, Buckley RA, et al. Does spinal kyphotic deformity influence the biomechanical characteristics of the adjacent motion segments? An in vivo animal model. Spine. 1999. 24:2139–2146.

20. Robinson RA, Smith GW. Anterolateral cervical disk removal and interbody fusion for cervical disk syndrome. Bull Johns Hopkins Hosp. 1955. 96:223–224.

21. Robinson RA, Walker AE, Ferlic DC, Wiecking DK. The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg. 1962. 44:1569–1587.

22. Sawin PD, Traynelis VC, Menezes AH. A comparative analysis of fusion rates and donor-site morbidity for autogenous rib and iliac crest bone grafts in posterior cervical fusions. J Neurosur. 1998. 88:255–265.

23. Seifert V, Stolke D. Multisegmental cervical spondylosis: treatment by spondylectomy, microsurgical decompression and osteosynthesis. Neurosurgery. 1991. 29:498–503.

24. Seiler JG 3rd, Johnson J. Iliac crest autogenous bone grafting: donor site complications. J South Orthop Assoc. 2000. 9:91–97.

25. Song KJ, Lee KB. A preliminary study of the use of cage and plating for single-segment fusion in degenerative cervical spine disease. J Clin Neurosci. 2006. 13:181–187.

26. Zdeblick TA, Ducker TB. The use of freeze-dried allograft bone for anterior cervical fusions. Spine. 1991. 16:726–729.