Autogenous Tricortical Bone Graft Research Articles

Outcome of Anterior Cervical Decompression and Fusion for Cervical Spondylotic Myelopathy

Introduction: Anterior cervical discectomy and fusion (ACDF) is a common procedure for a patient with progressive spinal cord compression and severe neurological deterioration causing major disability. Surgery in anterior approach involves removal of osteophyte and disc materials for decompression of spinal cord with addition to the interposition of autogenous tricortical bone graft and stabilization by plate and screw.
 Objectives: To assess the clinical outcome, complications of anterior cervical decompression and fusion for cervical spondylotic myelopathy.
 Materials and Methods: This prospective interventional study was carried out in the Department of Orthopaedic Surgery, Combined Military Hospital, Dhaka from January 2015 to May 2017. Total of 24 cases of cervical spondylotic myelopathy was enrolled as a study sample. All were treated by an anterior cervical discectomy, fusion and stabilization by plate and screw. All patients were clinically and radiographically evaluated before and after surgery.
 Results: In the majority (62.5%) patients, the level of involvement was in C5/C6 and 92.8% had a satisfactory outcome. In 4.1% of cases, early complication like superficial wound infection was noted. Late complications were persistence of pain, numbness present in 7.2% cases. The fusion rate was 100% in this series.
 Conclusion: Anterior cervical decompression and fusion for cervical spondylotic myelopathy is a safe and effective procedure. It is associated with the highest fusion, least complications and relatively lower cost.
 Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 127-129

Comparison between Autogenous Bone Graft and Allogenous Cancellous Bone Graft in Medial Open Wedge High Tibial Osteotomy with 2-Year Follow-up

PurposeTo compare the radiographic and clinical results of medial open wedge high tibial osteotomy (OWHTO) using autogenous bone graft and allogenous cancellous bone graft for medial compartment osteoarthritis of the knee with two-year follow-up.Materials and MethodsFifty-one patients (52 knees) who underwent medial OWHTO from October 2007 to April. 2010 were included in the study. The patients were divided into group I (n=29) that received an autogenous tricortical bone graft and group II (n=23) that received an allogenous cancellous bone chip graft. The radiographic parameters (preoperative anatomical and mechanical femorotibial angles, modified tibial bone varus angle, and posterior tibial slope), clinical parameters, bone union period, and complications were evaluated from medical records.ResultsThe radiographic and clinical outcomes did not show significant difference between two groups. The average bone union period was 11.7 weeks in group I and 12.1 weeks in group II. The visual analog scale score on the first postoperative day was significantly higher in group I than group II.ConclusionsMedial OWHTO using allogenous cancellous bone graft for medial compartment osteoarthritis of the knee can be considered as an alternative treatment method that provides equivalent radiographic and clinical results of OWHTO using autogenous bone graft and causes less immediate postoperative pain.

Efficacy of anterior cervical fusion: Comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts

This retrospective study was designed to analyze and compare the efficacy and outcomes of anterior cervical fusion using titanium cages, polyetheretherketone (PEEK) cages and autogenous tricortical bone grafts. Fifty-five patients who underwent segmental anterior discectomy with a follow-up period up to 12 months enrolled in this study. They were divided into three groups: titanium cage with biphasic calcium phosphate ceramic (Triosite; Zimmer, Berlin, Germany) in group A ( n = 27); PEEK cage with Triosite in group B ( n = 9); and autogenous tricortical iliac crest bone graft in group C ( n = 19). The fusion rates after 6 months were 37.21% in group A , 93.3% in group B, and 84.85% in group C. The fusion rates after 1 year in groups A, B, and C were 46.51%, 100% and 100%, respectively. The PEEK cage is a viable alternative to autogenous tricortical bone grafts in anterior cervical fusion.

Complications of Multilevel Anterior Cervical Fusion

Objective: Although anterior cervical fusion is a standard procedure for most anterior cervical lesions, multilevel anterior cervical fusion with or without instrumentation remains a challenge due to the complexity of decision making and the high rate of complications as reported in the literature. Patients and Methods: During the period from June 1994 to June 1999, 49 cases of multilevel segmental anterior cervical fusion were retrospectively reviewed. Levels of fusion were determined mainly according to clinical presentations and related magnetic resonance imaging (MRI) findings. A modified Smith-Robinson surgical procedure and tricortical autogenous bone graft taken from the anterior iliac crest were used in all reviewed cases. Instrumentation was indicated only when there were 3 or more fusion levels, and/or when instability was documented. Complications including a painful donor site, transient dysphagia, instrumentation failure, hematoma formation, and spinal cord injury were analyzed. Results: Thirty-six patients (73.5%) received 2 levels of fusion, 11 patients (22.4%) received 3 levels of fusion, and 2 patients (4%) received 4 levels of fusion. Sixteen of 49 (32.6%) patients received plate and screw fixation. All patients achieved solid fusion by at least the 12-month follow-up. Complications included a painful donor site in 18 patients (36.7%), transient dysphasia in 16 patients (32.6%), instrumentation failure in 4 patients (8%), donor site hematoma in 1 patient (2%), and spinal cord injury in 1 patient (2%). Conclusions: Although the fusion rate of multilevel segmental anterior cervical fusion can be maximized if an autogenous tri-cortical bone graft is used and the stability is reinforced with instrumentation, the morbidity remained high. Alternative fusion materials such as a cage with or without an autogenous bone graft should be considered to avoid a painful donor site; meticulous surgical technique with intermittent retraction blade relaxation may decrease the incidence of dysphasia. Proper patient selection is important for avoiding unnecessary fusion levels and instrumentation.

Ankle and subtalar fusion utilizing a tricortical bone graft, bone stimulator, and external fixator after avascular necrosis of the talus

A unique ankle and subtalar fusion was performed on a patient with avascular necrosis of the talus. The body of the talus was removed and replaced with an autogenous tricortical bone graft. Healing was aided by the use of a bone stimulator and external fixator. The authors believe this fusion to be a more stable fusion than others used to treat avascular necrosis of the talus.

Operative treatment of bone overgrowth in children who have an acquired or congenital amputation.

Fifty-three children who were less than thirteen years old were followed for a median of seven years and ten months (range, two years and nine months to fourteen years and six months) after operative treatment for overgrowth of the tibia or humerus after amputation. During the thirty-one years in which these children were managed, three operative techniques were used in successive periods. Thus, the fifty-three children could be divided into three groups: thirty-one who had had a resection and revision, nine in whom the bone had been capped with a synthetic device, and thirteen in whom the bone had been capped with an autogenous tricortical bone graft from the iliac crest. A retrospective review was performed to determine the result and complications associated with each of these techniques. Survival analysis revealed that subsequent procedures were performed in twenty-six (84 per cent) of the thirty-one patients who had had a resection and revision, in seven of the nine in whom the bone had been capped with a synthetic device, and in four of the thirteen in whom the bone had been capped with an autogenous bone graft. The estimated mean survival time (that is, the time to a subsequent procedure) was five years in the group that had had the bone capped with an autogenous graft and three years and six months in the group that had had resection and revision; the difference is significant (p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)