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Biomechanical stability of a bioabsorbable self-retaining polylactic acid/nano-sized β-tricalcium phosphate cervical spine interbody fusion device in single-level anterior cervical discectomy and fusion sheep models
Cao L, Duan PG, Li XL, Yuan FL, Zhao MD, Che W, Wang HR, Dong J
International Journal of Nanomedicine , 2012, DOI: http://dx.doi.org/10.2147/IJN.S38288
Abstract: iomechanical stability of a bioabsorbable self-retaining polylactic acid/nano-sized β-tricalcium phosphate cervical spine interbody fusion device in single-level anterior cervical discectomy and fusion sheep models Original Research (1094) Total Article Views Authors: Cao L, Duan PG, Li XL, Yuan FL, Zhao MD, Che W, Wang HR, Dong J Published Date November 2012 Volume 2012:7 Pages 5875 - 5880 DOI: http://dx.doi.org/10.2147/IJN.S38288 Received: 19 September 2012 Accepted: 30 October 2012 Published: 27 November 2012 Lu Cao,1 Ping-Guo Duan,1 Xi-Lei Li,1 Feng-Lai Yuan,3 Ming-Dong Zhao,2 Wu Che,1 Hui-Ren Wang,1 Jian Dong1 1Department of Orthopedic Surgery, Zhongshan Hospital, State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, China; 2Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, China; 3Affiliated Third Hospital of Nantong University, Wuxi, China Purpose: The aim of this study was to investigate the biomechanical stability provided by a novel, polylactic acid/nano-sized, β-tricalcium phosphate, bioabsorbable, self-retaining cervical fusion cage (BCFC). Methods: Quasistatic nonconstraining torques (maximum 1.5 NM) induced flexion, extension, lateral bending (±1.5 NM), and axial rotation (±1.5 NM) on 32 sheep cervical spines (C2–C5). The motion segment C3–C4 was first tested intact; the following groups were tested after complete discectomy: autologous tricortical iliac crest bone graft, Medtronic–Wego polyetheretherketone (PEEK) cage, Solis PEEK cage, and BCFC. The autologous bone graft group was tested with an anterior plate. The mean range of motion (ROM) was calculated from the load-displacement curves. Results: BCFC significantly decreased ROM in lateral bending and axial rotation compared to other implants, and no significant difference in ROM between two types of PEEK cages and BCFC could be observed in flexion and extension. Anterior cervical plate (ACP) significantly decreased ROM in flexion and extension, but no significant difference in ROM between BCFC and bone graft plus ACP could be determined in lateral bending and axial rotation. Conclusion: The BCFC device showed better stability to autologous tricortical iliac crest bone graft and PEEK cages in single-level anterior cervical discectomy and fusion models and thus may be a potential alternative to the current PEEK cages.
The NEtherlands Cervical Kinematics (NECK) Trial. Cost-effectiveness of anterior cervical discectomy with or without interbody fusion and arthroplasty in the treatment of cervical disc herniation; a double-blind randomised multicenter study
Mark P Arts, Ronald Brand, Elske van den Akker, Bart W Koes, Wilco C Peul
BMC Musculoskeletal Disorders , 2010, DOI: 10.1186/1471-2474-11-122
Abstract: Patients (age 18-65 years) presenting with radicular signs due to single level cervical disc herniation lasting more than 8 weeks are included. Patients will be randomised into 3 groups: anterior discectomy only, anterior discectomy with interbody fusion, and anterior discectomy with disc prosthesis. The primary outcome measure is symptomatic adjacent disc degeneration at 2 and 5 years after surgery. Other outcome parameters will be the Neck Disability Index, perceived recovery, arm and neck pain, complications, re-operations, quality of life, job satisfaction, anxiety and depression assessment, medical consumption, absenteeism, and costs. The study is a randomised prospective multicenter trial, in which 3 surgical techniques are compared in a parallel group design. Patients and research nurses will be kept blinded of the allocated treatment for 2 years. The follow-up period is 5 years.Currently, anterior cervical discectomy with fusion is the golden standard in the surgical treatment of cervical disc herniation. Whether additional interbody fusion or disc prothesis is necessary and cost-effective will be determined by this trial.Netherlands Trial Register NTR1289Anterior cervical discectomy (ACD) is the basic surgical treatment of patients with radicular pain caused by cervical disc herniation. In 1958, Cloward, Smith and Robinson first described anterior cervical decompression with the use of autologous iliac crest interbody graft (ACDF)[1]. Shortly after, Hirsch debated the necessity of interbody fusion[2]. The results of various prospective randomised trials suggest that interbody fusion may not be necessary in all cases, although due to methodological flaws no solid conclusions can be drawn[3-9]. The Cochrane Review even mentioned advantages of anterior discectomy only (e.g. costs, operation time and return to work)[10].At present, ACDF is defined as the golden standard for cervical disc herniation to maintain disc height, cervical alignment, and promote bony f
Polymethylmethacrylate-assisted ventral discectomy: Rate of pseudarthrosis and clinical outcome with a minimum follow-up of 5 years
Mario Cabraja, Daniel Koeppen, Wolfgang R Lanksch, Klaus Maier-Hauff, Stefan Kroppenstedt
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-140
Abstract: From 1986 to 2004 416 patients underwent ventral discectomy and PMMA interposition for DDD. The clinical and radiological outcome was assessed for 50 of 127 eligible patients after a mean of 8.1 years. Based on postoperative radiographs the patients were dichotomized in those with a pseudarthrosis (group A) and those with solid arthrodesis (group B).Pseudarthrosis with movement of more than 2 of the operated segment was noted in 17 cases (group A). In 33 cases no movement of the vertebral segment could be detected (group B). The analysis of the clinical data assessed through the neck disability index (NDI), the visual analogue scale (VAS) of neck and arm pain and Odom's criteria did not show any significant differences between the groups.Patients from group B showed a trend to higher adjacent segment degeneration (ASD) than group A (p = 0.06). This correlated with the age of the patients.PMMA assisted discectomy shows a high rate of pseudarthrosis. But the clinical long-term success does not seem to be negatively affected by this.Ventral microdiscectomy and fusion are currently the golden standard in surgical treatment of degenerative disc disease (DDD)[1-3]. There is nevertheless an ongoing discussion as to which fusion substrate provides the best clinical and radiological outcome. Autologous iliac bone crest, allograft bone, titanium, polyetheretherketone (PEEK) or carbon cages are widely used graft materials. Polymethylmethacrylate (PMMA) is another substitute for removed discs [4], but there have been reports of higher rates of graft migration and pseudarthrosis for PMMA compared to carbon- or titanium cages [5-7]. Another major concern with using PMMA in ventral discectomy is unsatisfying results in restoring disc height and sagittal alignment [1,7,8]. Nevertheless, PMMA is an economic alternative to titanium and PEEK implants [9,10].The concept of spinal fusion in the treatment of DDD is currently being questioned as recent developments in spinal surgery move
Tricortical cervical inter-body screw fixation.  [cached]
Goel A
Journal of Postgraduate Medicine , 1997,
Abstract: A new tricortical method of screw implantation for anterior cervical interbody plate fixation is described. The screws are placed obliquely such that they engage the anterior cortex of the body and traverse through the cortices adjoining the disc space. By this method the screws not only hold the plate firmly with a tricortical purchase, but by virtue of their course stabilize the two adjoining vertebral bodies by themselves. Sixteen patients were treated by this method. In three of these cases only tricortical screws without the metal plate were used for fixation. The advantages of the technique are discussed.
Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage)
Bjarne Lied, Paal Roenning, Jarle Sundseth, Eirik Helseth
BMC Surgery , 2010, DOI: 10.1186/1471-2482-10-10
Abstract: This was a non-randomized prospective single-center outcome study of 258 patients who underwent ACDF for cervical disc degeneration (CDD). Fusion was attained with either tricortical AICG or PEEK cages without additional anterior plating, with treatment selected at surgeon's discretion. Radicular pain, neck-pain, headache and patient satisfaction with the treatment were scored using the visual analogue scale (VAS).The median age was 47.5 (28.3-82.8) years, and 44% of patients were female. 59% had single-level ACDF, 40% had two level ACDF and 1% had three-level ACDF. Of the patients, 181 were fused with AICG and 77 with a PEEK-cage. After surgery, the patients showed a significant reduction in radicular pain (ΔVAS = 3.05), neck pain (ΔVAS = 2.30) and headache (ΔVAS = 0.55). Six months after surgery, 48% of patients had returned to work: however 24% were still receiving workers' compensation.Using univariate and multivariate analyses we found that high preoperative pain intensity was significantly associated with a decrease in pain intensity after surgery, for all three pain categories. There were no significant correlations between pain relief and the following patient characteristics: fusion method (AICG or PEEK-cage), sex, age, number of levels fused, disc level fused, previous neck surgery (except for neck pain), previous neck trauma, or preoperative symptom duration. Two hundred out of the 256 (78%) patients evaluated the surgical result as successful. Only 27/256 (11%) classified the surgical result as a failure. Patient satisfaction was significantly associated with pain relief after surgery.ACDF is an effective treatment for radicular pain in selected patients with CDD after six months follow up.Because of similar clinical outcomes and lack of donor site morbidity when using PEEK, we now prefer fusion with PEEK cage to AICG.Lengthy symptom duration was not a negative prognostic marker in our patient population.The number of patients who returned to work 6 mont
Osteotomia proximal da tíbia: estabiliza??o da abertura medial com enxerto tricortical de ilíaco
Luciano, Roberto da Cunha;Souza, Getúlio Danival de Moura;Rispoli, Juliano;Cardoso, Rodrigo Galv?o;Nascimento, Marcus Vinícius Martins do;Domingos, Gustavo Gontijo;Luciano, Dyego Vilela;
Revista Brasileira de Ortopedia , 2010, DOI: 10.1590/S0102-36162010000600006
Abstract: objective: roentgenographic assessment of lower limb alignment, in the frontal and sagittal planes, after a high tibial osteotomy. to stabilize the osteotomy, a tricortical iliac graft was used along with a positioning screw. methods: prospective study of 46 patients with ages ranging from 17 to 61 years. among them, 42 patients were carriers of genu varum secondary to knee osteoarthritis and four from other causes. radiography was performed for surgical planning, using the frank noyes method modified by fugizawa. three cm conventional surgical access was performed to remove a tricortical iliac graft. the osteotomy was performed under fluoroscopic control, by 3 cm anteromedial incision with release of the superficial portion of the medial collateral ligament. the graft was placed in the posterior portion of the osteotomy to maintain an unaltered tibial slope. the screw crossed the osteotomy orthogonally to protect the lateral cortex. radiographic criteria were established pre-and postoperatively to assess the results. results: there was consolidation in 100% of cases and maintenance of the mechanical axis, obtained intraoperatively in 94% of cases. correction of mechanical axis occurred in 94% (43 patients / 47 osteotomies). the posterior slope of the tibial plateau in the sagittal plane ranged from 7o to 12o. joint mobility was restored in all patients. eleven patients had temporary pain at the site of graft removal, however, none had paraesthesia. the incidence of complications was 8% (infection, loss of correction, joint fracture). conclusion: this technique is reproducible, simple, biologic, accurate, low-cost, and can be used as an alternative to existing techniques.
Initial Experience with BoneBac PressTM: A Novel Autologous Bone Graft Harvesting and Collecting Device  [PDF]
Mick Perez-Cruet, Evan M. Begun, Robert Collins, Daniel Fahim
Open Journal of Orthopedics (OJO) , 2013, DOI: 10.4236/ojo.2013.35045
Abstract: Object: The objective of this study is to analyze the utility of a novel autologous bone graft harvesting and collecting device in spinal fusion surgeries. Methods: 35 patients underwent fusion procedures in the cervical or lumbar spine using the BoneBac PressTM. Procedures included anterior cervical discectomy with fusion (ACDF), lumbar laminectomy and posterolateral arthrodesis, and transforaminal lumbar interbody fusion (TLIF). The amount of bone graft collected from each level was determined as well as the need for additional bone graft extenders. Fusion rates were determined based on an independent radiographic evaluation performed 5 to 12 months postoperatively. Results: 54 total levels were operated upon, collecting a total of 176.0 cc of autograft. The average amount of bone collected was 3.26 cc/level. In the cervical and lumbar spine the average amount of bone collected per level was 2.30 cc and 6.77 cc respectively. The fusion rate was 94.3% at 10 months postoperatively. In most cases no additional bone graft extender was needed. Autologous bone collected had excellent handling characteristics and was easily packed into cages or placed posterolaterally. Conclusions: The use of autograft bone material collected using the BoneBac PressTM is costeffective, significantly reduces bone graft cost, and eliminates donor graft site morbidity while promoting successful fusion.
Evaluation of arthrodesis and cervical alignment in the surgical results of cervical discectomy using polymethylmetacrylate
Mudo, Marcelo Luis;Amantea, Andrea Vieira;Joaquim, Andrei Fernandes;Prandini, Mirto Nelso;Cavalheiro, Sérgio;
Arquivos de Neuro-Psiquiatria , 2009, DOI: 10.1590/S0004-282X2009000500017
Abstract: background and objectives: surgical treatment of cervical radiculopathy with or without myelopathy is a controversy issue, although anterior discectomy is the most common form of treatment. method: we present the evaluation of the arthrodesis' rate and cervical alignment in 48 patients with cervical degenerative disease (cdd) submitted to anterior cervical discectomy with interposition of polymethylmetacrylate (pmma). odom and nürick scales were used to evaluation of functional status before and after surgery. cervical spine x-rays were used to access arthrodesis and alignment, at least 2 years after the procedure. results: excellent and good results (odom i and ii) were obtained in 91% of the patients with radiculopathy and in 69% of those with myelopathy. using the chi square test of independence (1% of significance), there was no association between excellent and good clinical results with the presence of arthrodesis verified in cervical x-rays. the presence of cervical alignment had association with good results, whereas the misalignment was associated with unfavorable outcomes. two patients died: one cervical hematoma and other from graft migration with cord compression. conclusions: cervical alignment was more important than fusion to achieve good surgical results in cdd.
Spontaneous resorption of extruded iliac crest graft ina case of high cervical myelopathy
Kumar R,,Chatleya A,,Mahapatra AK
Journal of Mazandaran University of Medical Sciences , 2008,
Abstract: A 38 year old male patient presented to us with complaints of parasthesias in all four limbs with spastic quadriparesis. Magnetic resonance imaging of cervical spine revealed central disc herniation at C2-C3 level with significant cord compression. He was operated for C2-C3 Smith-Robinson anterior cervical discectomy. An autogenous tricortical iliac crest graft of 1.5×1.0 cm was snugly fitted into the disc space. Postoperative check X-ray of the cervical spine showed extrusion of the graft. The patient was managed conservatively. Repeat X-ray of the cervical spine after follow-up of 6 weeks showed resorption of the graft. The distinct strategy of management in this case along with a brief review of literature is discussed.Key words: High cervical myelopathy: Extruded graft: Resorption
Induced-pluripotent stem cells seeded acellular peripheral nerve graft as “autologous nerve graft”  [PDF]
Jiang Li, Guo-Dong Gao, Ti-Fei Yuan
Journal of Biomedical Science and Engineering (JBiSE) , 2010, DOI: 10.4236/jbise.2010.31012
Abstract: The hypothesis is that induced pluripotent stem cells (iPSC) derived Schwann cells and/or macrophages can be transplanted into acellular nerve graft in repairing injured nervous system. The efficiency of iPSC seeded acellular nerve graft may mimic the autologous peripheral nerve graft.
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