The Hartshill Horseshoe The Treatment of Chronic Pain Patients with Discogenic Pain in the Absence of Neural Compression A Prospective 2[half]- to 3-Year Review

Abstract

Interbody fusion is a well-recognized technique to achieve spinal fusion. The advantage of using tricortical blocks as opposed to the dowel technique is that intervertebral disc height can be restored. Both techniques can be performed either by the anterior or posterior approach. The traditional tricortical block technique has advantages over using dowels as it is a more stable construct and can restore intervertebral disc height. However, autologous bone graft has an unpredictable behavior causing potential problems of disc space collapse, forward displacement of the graft and donor bone graft site morbidity. The Hartshill horseshoe was developed to overcome these autograft problems. It is an implant that is placed within the periphery of the intervertebral disc space where the vertebral end plate is strongest to resist compression forces. It has holes that allow screw fixation of the implant to bone to provide immediate stability and a central area for bone graft where the vertebral body is most vascular to allow incorporation of such a graft. Previous reports on the Hartshill horseshoe have used autograft (single tricortical graft). This prospective study reports the clinical and radiological results of 19 patients who underwent this procedure using xenograft 2½ to 3 years postoperative. The radiological results do not show any evidence of loosening of the screws or implant nor evidence of intervertebral disc space subsidence. It was not possible to assess the exact incidence of spinal fusion.