Iliac Autograft Research Articles

Collective commentaries regarding two articles disputing value of cervical disc arthroplasty vs. Anterior cervical diskectomy and fusion.

Collective commentaries regarding two articles disputing value of cervical disc arthroplasty vs. Anterior cervical diskectomy and fusion.

Histological characteristics of induced membranes in subcutaneous, intramuscular sites and bone defect

The induced membrane technique was proposed as a treatment of large segmental bone defects. The influence of the surrounding tissues on its characteristics remains unknown. It is therefore not known which kind of plastic surgery procedure (muscular or facio-cutaneous flap) would optimize bone osteointegration within a bone defect reconstructed using the induced-membrane technique. We hypothesized that membrane characteristics could be influenced by the soft-tissue environment either subcutaneous or muscular. To evaluate the histological characteristics of poly-methylmethacrylate (PMMA) induced membranes in intramuscular, subcutaneous and bony environment (radius defects) at 2 steps: spacer implantation; secondary bone graft and its subsequent osteintegration after spacer removal. PMMA-induced membranes were obtained in the three sites of 15 rabbits. Subsequent new bone formation was studied in the same environments in 24 other rabbits. Six weeks after the initial implantation, PMMA spacers were replaced with iliac autografts. Animals were euthanized at 2, 4, and 8 weeks postoperatively. Tissue samples were harvested and stained with hematoxylin and eosin. The histological characteristics of the membrane (thickness and microvessel density) and the newly-formed bone (cortical thickness) were quantitatively analyzed. The membranes in the subcutaneous sites developed quicker, were thicker and had the lowest microvessel density (P<0.01). The membranes in the intramuscular sites developed later and were thinner (P<0.01). The membranes in the osseous defects had the greatest microvessel density (P<0.01). After bone grafting, induced membranes became thinner and their microvessel density decreased substantially, but maintained better in osseous site. The newly-formed bone that developed in the radius defects, had the thickest cortices (P<0.01). The evolution of membranes induced in the intramuscular and subcutaneous environments was close to that of the bone defect model, although bone formation appeared weaker.

The Efficacy of Stand-Alone PEEK Cages versus Locking Plate in Three or More-Level Anterior Cervical Discectomy and Fusion

Background Data: Anterior cervical discectomy and fusion (ACF) is currently the gold standard for surgical treatment of cervical degenerated disease (CDD). For many years, patients were treated with ACF using tricortical autogenous bone graft augmented with anterior cervical locking plate. Later, Cages packed with calcium triphosphate bonesubstitute were the treatment of choice. Study Design: A comparative clinical case study. Purpose: Compare the outcomes of ACF using stand-alone PEEK cages packed with calcium triphosphate bone substitute compared with tricortical iliac autograft augmented with anterior locking plate in treatment of three or more-level CDD in 47 patients.Patients and Methods: We evaluated 47 patients (22 patients in the locking plate group and 25 patients in the cage group) at our institution from January 2007 to September 2010. They were followed up for minimum 2 years. The clinical outcomes (Nurick grade and JOA score), radiographic changes (local kyphotic angle (LKA), fusion, subsidence,and adjacent disc degeneration), and complications were compared between the 2 groups. Results: The blood loss was significantly less in cage group (388 cc) than plate group (529.6cc).Both groups showed significant improvement in LKA postoperatively and at latest follow up with no significant difference. Fusion was 94.1% and 94.4% in cage andplate groups in order. There was insignificant more subsidence in cage (21.4%) than plate group (11.3 %). There was significant improvement in Nurick grading of both cage and plate groups as it improved from 3.32 and 3.68 preoperatively to 0.84 and 1.05 at latest follow up in order with no significant difference between the two groups. Final outcome was comparable in both groups: In cage group: excellent in 7 patients, good in 16, and fair in 2. In plate group, excellent in 8 patients, good in 11, and fair in 3. Conclusion: In multiple levels (three or more) ACF, the use of stand-alone PEEK cagesresults in less blood loss, less adjacent disc degeneration, less complications than the use of autograft augmented with locking plate but unfortunately, more incidence of subsidence. However, there is no significant difference in the postoperative and latest follow up LKA, fusion rate, clinical, and functional outcomes between the cage and plategroups. (2013ESJ049)

Failure of Porous Tantalum Cervical Interbody Fusion Devices

The objective of this study was to assess the safety and efficacy of 2 novel cervical interbody fusion devices in the treatment of single-level degenerative cervical disk disease. Both devices were fabricated from a porous tantalum material. The high overall porosity of the devices was intended to facilitate anterior cervical interbody fusion. A prospective, randomized, 3-armed, clinical study was initiated with the following treatment groups: porous tantalum ring device packed with autograft, porous tantalum block device, and iliac crest autograft control. All the patients had single-level symptomatic cervical disk disease that had failed to respond to nonoperative therapy. Clinical and radiographic data were collected preoperatively, during surgery, before hospital discharge, and at 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively. Six investigators participated in the clinical study at 6 investigational centers in the United States. Enrollment into the study was terminated after 39 patients had been accrued because of concerns over delayed fusion in the porous tantalum treatment groups. Of the 39 patients enrolled into the clinical study, 11 patients received the control treatment of iliac autograft fusion, 13 patients received the porous tantalum ring device with the center cavity packed with cancellous iliac crest autograft, and 15 patients received the porous tantalum block device. These patients were evaluated for 24 months as per the study protocol. There were no significant differences in any of the patient demographic variables collected. The mean operative times for both the ring and block device groups were slightly lower than the control treatment. Two patients in the block treatment group were determined to be nonunion between the 6- and 12-month time points and underwent additional surgery. Five patients with porous tantalum devices showed radiographic evidence of device fragmentation, and one patient in addition had radiographic evidence of erosion of the involved vertebral bodies by the device. One patient in the ring treatment group died from a myocardial infarction and kidney failure subsequent to the 12-month follow-up visit, which was unrelated to the device or the spinal fusion procedure. Fusion rate at 2 years for the tantalum device was very low as compared with the control arm (44% vs. 100%). Patient Neck Disability Index scores, Short Form-36 scores, and neurological status scores were similar between the 3 treatment groups. This study demonstrates that stand-alone porous tantalum material is not ideal for a cervical spine interbody fusion because of the low rate of arthrodesis and the risk of device fragmentation in patients who fail to fuse.

Comparative assessment of blood circulation at critical zones of anastomoses in urinary bladder reconstruction with iliac graft

Aim. To improve the instant results of urinary bladder reconstruction with iliac graft by examination of critical zones. Methods. Urinary bladder reconstruction using the iliac autograft was performed in 15 patients without special examination of critical zones (control group) and in 25 patients in whom these zones were examined (main group). Mean age of patients was 58 years (from 44 to 68). All patients underwent cystectomy because of urinary bladder cancer (stages T2-4N0M0). Blood microcirculation at the stitch area was performed by M.Z. Sigal, tissue viability index by M.R. Ramazanov was calculated, oxygen saturation of arterial blood was measured and microcirculatory blood flow was examined by the LAKK-01 machine. The same surgery and research methods were performed in 70 dogs with regular assessment of microcirculation at the stitch area (stitch color, arterial pulsation) and using the tensiometry by M.Z. Sigal, microcirculation at the stitch area, oxygen saturation of arterial blood and stitch tissue viability index were also determined. Results. In patients of the control group, in whom the condition of critical zones was not examined, 3 has developed a stitch dehiscence at the zones of anastomosis, with no such events registered in patients from the main group, in whom critical zones were examined. In dogs stitch dehiscence was not observed only in the group where microcirculation was assessed by tissue viability index calculation. Conclusion. It is important to examine critical zones of the iliac autograft and calculate the stitch tissue viability index performing urinary bladder reconstruction with iliac graft to prevent the stitch dehiscence.

Comparison of 3 Fusion Techniques in the Treatment of the Degenerative Cervical Spine Disease. Is Stand-Alone Autograft Really the “Gold Standard?”

A prospective study. The aim of this study was to compare the 3 different methods of interbody fusion of the cervical spine-autograft in stand-alone technique, autograft with anterior plate, and polyetheretherketone cage supported by anterior plate. The clinical and radiological data obtained were analyzed and discussed. Although degenerative cervical spine disease has been treated by an anterior approach for more than 50 years, there is not one generally accepted operative approach. There is a very low-quality evidence of little or no difference in pain relief between each of the techniques. Iliac crest autograft still seems to be the "gold standard" for interbody fusion. Prospective study collecting clinical and radiological data of 81 patients undergoing anterior cervical interbody fusion, in which the interbody fusion of 1 or 2 motion segments from C3 to C7 was done by any of the 3 techniques--stand-alone insertion of autograft (group 1: 28 patients), autograft and anterior plate (group 2: 18 patients), and polyetheretherketone cage filled with beta-tricalcium phosphate and plate (group 3: 29 patients). Patients were followed for 2 years after surgery. Significant interaction of relative height in the segment and time was found (P < 0.001). The values of the relative height of stand-alone autograft dropped below 95% of initial height and the values of the other 2 groups remained above 105%. Significant interaction of time and group was found for Cobb S angles (P < 0.001). Values of group 1 decreased substantially and remained significantly lower than values of other 2 groups. Fusion rate was 100% in all groups. Neck Disability Index group and time interaction was found (P = 0.023). During postoperative follow-up, group 1 scored in all controls higher than the other 2 groups, but differences were not significant. Visual analogue scale showed effect of time (P < 0.001). This was due to a smaller improvement of patients in group 1 during the whole follow-up in comparison with the other 2 groups. Highest proportion of unsatisfied patients was in group 1 compared with the other 2 groups after 2 years (P = 0.034). Significantly worse radiological and clinical results after 2 years of follow-up were achieved using stand-alone autograft technique in comparison with autograft supported by anterior plating similarly as in comparison with cage implant and anterior plating. Using artificial fusion substrate together with plate and cage can offer the same clinical and radiological results such as iliac autograft and plating. Anterior plating seems to be an important factor influencing the postoperative cervical spine alignment and also the clinical outcome.

Effects of intermittent injection of parathyroid hormone related peptides on posterolateral lumbar fusions in rats model

Objective To assess the effect of intermittent subcutaneous injection of ( Gly1,Arg19 )human parathyroid hormone (hPTH) (1-28 [“G1,R19 ( 1-28 )”],hPTH ( 1-34 ) and ( Gly1,Arg19 ) hPTH (1-34) [“G1,R19 (1 -34 )”] on posterolateral lumbar fusions in a rat model.Methods Thirty-two Sprague-Dawley rats were subjected to posterolateral intertransverse fusion with iliac bone autograft at L4-L5.After surgery,all Sprague-Dawley rats were randomized into 4 groups (n =8 each).Rats received G1,R19 (1-28) (200 μg/kg),hPTH(1-34) (15 μg/kg),G1,R19(1-34) (30 μg/kg) or saline (control) via infrascapular region subcutaneously at the third day after surgery (once every day,5 days per week).All rats were sacrificed 6 weeks after surgey by cervical dislocation.The L4-L5 segments were removed,and analyzed with manual palpation,X-ray,bone mineral density (BMD) and bone mineral content (BMC) in the fusion segments,Micro-CT and histology.Results At 6th week,manual palpation revealted that the fusion rate was 37.5％,50.0％,87.5％ and 50.0％ in G1,R19(1-28) group,hPTH(1-34) group,G1,R19 ( 1-34 ) group and control group respectively.By radiographic scoring system,the scores in G1,R19(1 -28) group hPTH( 1-34 ) group,G1,R19 ( 1-34 ) group and control group were ( 1.88 ± 1.36),(2.58 ±1.32),(3.88 ±0.75 ) and ( 2.54 ±1.32) respectively at 6th week after operation.BMD of the fusion segments in G1,R1g(1-34) group was higher than in other groups.BMC of the fusion segments in G1,R19 (1-34) group was higher than in other group (P ＜ 0.01).By micro-CT,fusion bone volume in G1,R19(1 -28) group,hPTH (1-34) group,G1,R19(1-34) group and control group was quantified as (294.358 ±49.481),(343.340 ± 106.744),(401.010 ±97.120) and (339.790 ±44.200) mm3 respectively.Conclusion Intermittent subcutaneous injection of [“G1,R19 (1-34)”] can raise the rate and area of posterolateral lumbar fusions in the rat model,and the effect is more notable than that of hPTH(1-34). Key words: Spinal fusion; Parathyroid hormone; Bone transplantation

Maxillary sinus augmentation with iliac autograft – a health‐economic analysis

To estimate and compare the costs of maxillary sinus augmentation performed with autologous bone graft either from the iliac crest or from local bone harvested from the mandibula. To evaluate post-operative health-related quality-of-life parameters for patients subjected to sinus augmentation and iliac bone surgery. The hospital records of 14 patients subjected to sinus augmentation with iliac autograft, and 14 patients treated with local autograft, were analysed with regard to costs related to surgery, hospitalization and sick leave. Post-operative health parameters were assessed with a questionnaire. Mean hospital costs, administration excluded, for sinus augmentation with iliac autograft was €3447. Policlinic treatment alternatives e.g. local bone autograft with or without bone substitutes, rendered costs of approximately 42% thereof. The loss of production for a worker was 41% of the total cost (€9285). With regard to health-related quality-of-life and post-operative morbidity, most of the patients had recovered 14 days after the iliac graft surgery. The cost for a sinus augmentation with iliac surgery exceeds that of a policlinic procedure manifold. Provided that a policlinic operation with local bone, with or without bone substitute, renders an adequate end result, the economic gain would be substantial and post-operative morbidity would be greatly reduced.

Avascular Necrosis of the Hamate Treated With Capitohamate and Lunatohamate Intercarpal Fusion

This article describes a case of a 58-year-old man with no significant underlying disease who had chronic pain due to osteonecrosis of the hamate. Following physical examination, imaging, and laboratory findings, he underwent surgical exploration via a limited dorsal approach. The hamate bone did not have a normal anatomical appearance or structure. It was marble-like in appearance, soft, friable, and lacking physiologic contour and bone strength. We removed the dorsal aspect of the hamate piecemeal. The articular surfaces of the adjacent carpal bones (capitate and lunate) were excised, and the lesion was packed with iliac autograft. Three months postoperatively, fusion of the remaining hamate and the adjacent capitate and lunate carpal bones was evident, and the patient reported mild wrist pain, moderate grip strength improvement, and mild improvement of wrist range of motion and stiffness. Currently, no standard treatment algorithm exists for patients with avascular necrosis of the hamate. However, delayed diagnosis of this clinical entity can be debilitating. A high index of clinical suspicion and an early course of treatment offers considerable benefits to patients with osteonecrosis of the hamate.

Hybrid Grafting Using Bone Marrow Aspirate Combined With Porous β-Tricalcium Phosphate and Trephine Bone for Lumbar Posterolateral Spinal Fusion

A prospective, comparative study. We developed a hybrid graft (HBG) of porous β-tricalcium phosphate ceramics/percutaneously harvested bone sticks/autologous bone marrow aspirate for lumbar posterolateral fusion (PLF). The aim of this study was to investigate the efficacy of the HBG as a substitute for conventional corticocancellous iliac autografts. Iliac crest bone graft (ICBG) has been traditionally used as the golden standard for lumbar spinal fusion. The significant complication rate associated with harvesting corticocancellous ICBG, however, has encouraged development of alternative graft substitutes. From September 2005, 61 consecutive patients underwent decompressive laminotomy and 1-level instrumented PLF. Each patient in this study had the constructs of the HBG placed on 1 side of the intertransverse process gutter. An autologous local bone graft (LBG) harvested during decompressive laminotomy was placed on the other side as a control. Radiographic evaluation was performed at 6 months, 1 year after surgery, and subsequently on an annual basis. The fusion statuses on either side of vertebra were compared. The flexion-extension motion in the dynamic x-rays at the target level decreased over time. Only 1 case exhibited over 5° of angular motion 2 years after surgery. In the evaluation of fusion status, the fusion rate for the HBG side (68.9% at 6 months, 83.6% at 1 year, 93.5% at 2 years) was higher than that for the LBG side (49.2% at 6 months, 75.4% at 1 year, 89.1% at 2 years) with a significant difference at 6 months after surgery. No significant complications at the donor site were found postoperatively. The HBG promoted posterolateral spinal fusion without significant donor site morbidity. Because of its efficacy and safety, this hybrid construct seems promising as an alternative to conventional iliac bone grafts for lumbar spinal fusion.

An early comparative analysis of the use of autograft versus allograft in anterior cervical discectomy and fusion.

ObjectiveThe purpose of this study is to verify the usefulness of autograft versus allograft in the radiographic and clinical outcome in early period after the surgery.MethodsWe performed a retrospective review of 38 patients who had undergone one- or two-level anterior cervical discectomy and fusion (ACDF) with rigid anterior plate fixation from March 2006 to May 2009. Interbody graft materials were iliac autograft (n=17) or with allograft (n=21). Fusion rate and graft collapse rate were assessed by radiographic analysis and clinical outcome was based on Odom's criteria.ResultsIn autograft group, 13 patients achieved successful bone fusion (65%), whereas 7 patients (31.8%) in allograft group. There was statistically significant between two groups (p<0.05). Comparing immediate postoperative radiograph with last follow-up, the mean graft collapse was noted 1.3mm(15.5% change) in autograft group, whereas 2.0mm(24.7% change) in allograft group. There was no statistically significant collapse rate in autograft group (p>0.05), but statistically significant in allograft group (p<0.05). Clinical outcome was excellent or good in 94.1% in autograft group, and 90.5% in allograft group.ConclusionIn study, anterior cervical interbody fusion with an allograft got a result of lower fusion rate and higher collapse rate compared with autograft in early period after surgery, and clinical outcome showed similar results in both groups.

Anterior Reconstruction With Nano-hydroxyapatite/polyamide-66 Cage After Thoracic and Lumbar Corpectomy

Cages are used to regain stability of the anterior spinal column following vertebrectomy, which could prevent significant donor-site morbidity from the iliac autograft harvesting and the risk of disease transmission associated with the allograft. The hollow, porous, cylindrical nanohydroxyapatite/polyamide 66 (n-HA/PA66) cage is a new nonmetallic cage device made by combining nanohydroxyapatite with polyamide 66. Few studies have examined its effectiveness and outcomes over a follow-up >2 years.We retrospectively studied 51 consecutive patients with acute traumatic thoracic or lumbar burst fracture who underwent anterior reconstruction with the n-HA/PA66 cage following single-level corpectomy. Radiologic parameters (radiographs and 3-dimensional computed tomography scans) preoperatively and at 1 week and >2 years postoperatively, as well as clinical outcome parameters (SF-36 scores), were analyzed. Mean kyphosis correction in the segment within the cage was 11.8°±7.1°, and mean loss of correction at last follow-up was 1.9°±2.1°. Osseous fusion was achieved in 90.2% of patients, and severe cage subsidence (settling >2 mm) was observed in 19.6% of patients at final follow-up. Significant differences were found in 7 of 8 health dimensions of the SF-36 between neurologically intact patients and neurologically injured patients. Our clinical results indicate that the n-HA/PA66 cage is an effective device for reconstruction after anterior thoracic and lumbar vertebral resection, resulting in a high rate of successful osseous fusion and a low proportion of severe cage subsidence.

Nano-artificial bone and iliac autograft for unstable C type distal radius fracture: a comparison of efficacies

Nano-artificial bone and iliac autograft for unstable C type distal radius fracture: a comparison of efficacies

Double dorsal locking plates for unstable distal radial fractures

Objective To evaluate clinical results of double dorsal locking plates used in the fixation of distal radial fractures.MethodsFrom March 2007 to December 2009, 22 patients with distal radial fractures were fixed with double dorsal anatomical locking plates. They were 12 males and 10 females, with a mean age of 47. 5 years (21 to 78 years). By AO classification, there were one case of type A3, 5 cases of type B2, 2 cases of type C1, 11 cases of type C2 and 3 cases of type C3. Iliac autograft was performed in 5 patients. Clinical results and postoperative functional recovery were assessed by range of motion, grip strength, radiographic measurements of ulnar inclination, palmar tilt and radial height, the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire and the Gartland-Werley sere.Results The mean follow-up was 19 months (12 to 32 months). All fractures united within 6 months (2 to 6 months). The mean ulnar inclination angle was 25.3° (22° to 29°), the mean palmar tilt angle was 12.1° (8° to 14°), and the mean radial height was 1.1 cm (0.8 to 1.3 cm). The mean radiographic Stewart score was excellent or fine in 90. 9％ of the patients. The mean dorsal extension was 53° (30° to 68°), the mean palmer flexion was 47° (32° to 65°), the mean ulnar inclination was 22° (16° to 30°), the mean radial inclination was 14° (11° to 32°), the mean pronation was 76° (30° to 90°) and the mean supination was 72° (10° to 90°). The mean grip strength of the operated side was 72％ (15 kg) of the normal side. The mean Q-DASH and Gartland-Werley scores were 11.4 (0 to 70) and 3.4 ( 1 to 16), respectively.Conclusions Fixation with double dorsal locking plates for unstable distal radial fractures can result in fine clinical results, especially for those with comminuted dorsal hone cortex. Key words: Radius fractures; Fracture fixation, internal; Bone plates

Spinal fusion using tissue engineered bone. A prospective, randomized clinical pilot trial

Spinal fusion is performed using bone harvested from the ilium. However, graft harvest is associated with frequent complications and pain. If a tissue engineered bone (TEB) was available, spinal fusion could be performed without damaging normal tissues. In 8 patients, 10-20 mL of marrow fluid was collected from the iliac crest to fabricate. After primary culture in the standard medium, marrow mesenchymal cells were combined with porous tricalcium phosphate block and were cultured in osteogenic medium containing dexamethasone, b-glycerophosphate, vitamin C phosphate, and estriol. After 3 weeks of subculture, spinal fusion was performed using TEB. Nine patients who had undergone spinal fusion using iliac autografts served as the controls (AG group). In all patients, significant improvement in JOA score was seen in both TEB and AG groups. The radiographic fusion rate was 87.5% (7/8) in TEB group and 77.8% (2/9) in AG group at 6 months after surgery. The mean operating time in TEB group was shorter than in the AG group. Compared with the AG group, the patients receiving TEB graft had significantly less total blood loss. In the AG group, all of the patients complained of graft site pain for 2 to 4 weeks after the operation. Two patients (22.2%) still had graft site pain at 6 months postoperatively. Bone regeneration therapy using the TEB graft introduced in this report makes it possible to perform spinal fusion as is done using autogenous bone grafts, but with the minimally invasive procedure of bone marrow aspiration.

Efficacy of posterior cervical fusions utilizing an artificial bone graft expander, beta tricalcium phosphate

Background:Several cervical laminectomies and instrumented posterior cervical fusions utilize iliac autograft supplemented with demineralized bone matrix, or bone morphogenetic protein, but few utilize artificial bone graft expanders. Here we analyzed whether posterior cervical fusions could effectively utilize iliac autograft supplemented with an artificial bone graft expander, Beta Tricalcium Phosphate [B-TCP]Materials and Methods:Fifty-three severely myelopathic patients [average Nurick Score 4.1], averaging 65.3 years of age, underwent posterior cervical laminectomies [average 2.3 levels] and multilevel instrumented fusions [average 7.5 levels] utilizing iliac crest autograft and B-TCP. Pathology addressed included multilevel spondylosis accompanied by ossification of the posterior longitudinal ligament [24 patients], ossification of the yellow ligament [27 patients], and instability [53 patients]. Fusion rates [dynamic X-ray, two-dimensional computerized axial tomography (2D-CT) and outcomes [Nurick Grades, Odom's Criteria, SF-36] were assessed at 3, 6, and 12 months postoperatively.Results:Fusion was confirmed by two independent neuroradiologists utilizing dynamic X-ray studies [100% of patients] and 2D-CT studies [86.8% of patients] an average of 5.4 months postoperatively. Although there were no symptomatic pseudarthroses, three smokers exhibited delayed fusions [8 postoperative months]. Within 1 postoperative year, patients improved an average of 2.7 Nurick Grades [Nurick Score 1.4], Odom's criteria revealed 48 good/excellent, and 5 fair/poor outcomes, and improvement on all 8 SF-36 Health Scales [maximal on Bodily Pain [+21.96].Conclusions:High fusion rates and improved neurological outcomes were achieved within one year for 53 patients undergoing multilevel level cervical laminectomies with posterior instrumented fusions utilizing iliac autograft supplemented with B-TCP.

Efficacy and outcomes of dynamic-plated single-level anterior diskectomy/fusion with additional analysis of comparative costs

Background:Few studies focus on the fusion rates and outcomes for single-level anterior cervical diskectomy/fusion (1-ACDF) utilizing iliac autograft and dynamic plates.Methods:Fusion rates and outcomes were prospectively evaluated in 60 consecutive patients undergoing 1-ACDF utilizing iliac autograft and dynamic plates (ABC; Aesculap, Tuttlingen, Germany). Eighteen patients had radiculopathy, while 42 were myelopathic (average Nurick Score 3.3). Pathology included single-level disc disease/spondylosis (38 patients) and/or ossification of the posterior longitudinal ligament (OPLL, 22 patients). Fusion was assessed at 3, 6, and up to 12 months postoperatively utilizing dynamic X-rays and 2D-CT scans. Outcomes were evaluated up to 24 months postoperatively utilizing Odom's Criteria, Nurick Grades, and Short-Form 36 (SF-36) outcome questionnaires. Patients were followed for an average of 4.8 postoperative years (minimum 2 years).Results:Although dynamic X-rays/2D-CT studies documented 100% fusion an average of 3.8 months (range 2.5-8 months] postoperatively, 5 heavy smokers exhibited delayed fusions [6-8 months postoperatively]. Two years postoperatively, the average Nurick Score was 0.3 (mild radiculopathy), while Odom's Criteria revealed 52 excellent, 6 good, and 2 fair outcomes [the latter 8 patients were heavy smokers]). Utilizing SF-36 outcome questionnaires, patients markedly improved (>10.0 point gain) on 5 of 8 Health Scales within 6 months, 7 of 8 within 1 year, and all 8 within 2 postoperative years.Conclusions:For 60 patients undergoing 1-ACDF utilizing dynamic plates, ultimately a 100% fusion rate was achieved (5 heavy smokers exhibited delayed fusions). Two years postoperatively, Nurick Grades, Odom's Criteria, and SF-36 questionnaires revealed adequate outcomes.

Graft Options in Posterolateral and Posterior Interbody Lumbar Fusion

Review article, review of literature. To review the bone graft options that exist for posterolateral and posterior interbody lumbar fusion. As the number of lumbar fusion surgeries has increased over the last decade, alternative methods of grafting have been developed. Iliac crest autograft bone has traditionally been used for lumbar fusion. The downside to this graft option, however, is donor site morbidity. The current literature on alternatives to iliac crest autograft bone for obtaining lumbar fusion was reviewed. Platelet gels, demineralized bone matrix, synthetic bone graft, and bone morphogenetic protein are potential options for bone graft supplementation or substitution. In preclinical studies, platelet gels have been beneficial to bone growth when combined with autograft, but clinical studies do not support the use of platelet gel in posterolateral lumbar fusion. Preclinical studies of demineralized bone matrix have shown significant variability in the osteoinductive properties of the available products, and clinical data showing efficacy is limited. The use of synthetic bone graft material (ceramics) in lumbar fusion surgery is increasing. Calcium phosphate compounds (i.e., beta-tricalcium phosphate and hydroxyapetite) are most commonly used and are often combined with type I collagen to form a matrix. These materials provide an osteoconductive scaffold for bony ingrowth and can be combined with bone marrow aspirate or used as a carrier for osteogenic factors. Bone morphogenetic protein (rhBMP-2) has been shown to provide similar or even increased fusion rates over autograft iliac crest bone. There are, however, potential safety concerns associated with the use of bone morphogenetic protein that are not fully understood. Several alternatives to iliac crest autograft bone provide promising early clinical results in achieving posterolateral and posterior interbody lumbar fusion.

Combined arthroscopic-open procedure for the recurrent shoulder dislocation in a 74-year-old man with an irreparable massive rotator cuff tear and a large Hill-Sachs lesion

Large, engaging Hill-Sachs lesions can be one of causes for recurrent glenohumeral instability after initial anterior shoulder dislocation or Bankart repair for the torn anteroinferior labrum. However, there have been relatively few articles describing specific treatments for the humeral head defects. This article described a case of an alternative treatment for large Hill-Sachs lesion using the corticocancellous iliac autograft. The authors present a case of recurrent anterior shoulder dislocation, with a large humeral head defects, and an irreparable massive rotator cuff tear in a 74-year-old man. The size of this Hill-Sachs lesion was 2.7 × 2 cm with a depth of 1.2 cm. After arthroscopic anterior capsulolabral repair, a 3 × 2 cm semicircular graft was harvested from the inner table of anterior iliac crest, trimmed, and transplanted to the humeral defect by cancellous screw fixation. At his 2-year follow-up, the patient remained free of dislocation and apprehension. We recommend this technique as an alternative method for symptomatic patients with engaging Hill-Sachs lesion.

Surgical intervention and radiotherapy outcome of solitary plasmacytoma of cervical spine

To study the clinical features, treatment methods and outcome of solitary plasmacytoma of cervical spine. From January 1995 to December 2007, the data of 23 cases with solitary plasmacytoma of cervical spine was analyzed. There were 16 males and 7 females (mean age 56 years, range: 32 - 76 years). Two cases underwent radiotherapy alone and 21 patients received surgery. According to WBB staging system, surgical procedures were defined as total or subtotal resection (6 cases), appendix resection (4 cases), sagittal resection (3 cases) and total spondylectomy (8 cases). All surgical cases were managed using an anterior approach, posterior approach or combined anterior and posterior approach. The cervical spinal reconstruction was achieved through anterior cervical titanium plate and titanium mesh cage filled with auto iliac graft or bone cement, or anterior and posterior combined instrumented fusion. All patients received radiotherapy as adjunctive therapy. Follow-up of the 23 cases lasted 24.0 - 143.0 months (mean: 64.7 months). Neck pains obviously improved, and nerve compression symptoms disappeared or improved after surgery. Neurological function improved by 1 - 2 grades based on Frankel grading system. All the internal fixations were fused well and stability of the cervical spine was fine and no spine instability could be seen in our series. The bone graft fusion rate was 100%. During the follow-up period, 6 surgical cases had local recurrence and finally progressed to multiple myeloma (MM) and 3 died. Two cases without surgical treatment progressed to MM in 1 year and 1.5 years after confirmed diagnosis. They were given systemic chemotherapy. The other 15 patients had disease-free survival and after surgery and adjunctive radiotherapy. Obvious abnormity were not found in such examinations as M protein, bone marrow aspiration and emission computed tomography or PET-CT examinations. Solitary plasmacytoma of cervical spine is rarely seen clinically. Surgery is recommended as the primary management for patients with overt bone destruction and spinal instability or neurological dysfunction. Tumor excision with adjunctive radiotherapy can obviously reduce local recurrences and lower the possibility of progression to MM. The patients with progression to MM should receive chemotherapy according to chemotherapy protocol while the prognosis is comparatively worse.