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Ronald H. M. A. Bartels, Roland Donk and Roel van Dijk Azn

have never been studied. In this report we describe these effects after implantation of a carbon fiber cage (cervical I/F Cage; Depuy Acromed, Rotterdam, The Netherlands). Clinical Material and Methods Thirteen consecutive patients with a symptomatic cervical disc herniation and no history of neck surgery were studied. There were five women and eight men (mean age 46.2 years). All patients underwent a standard microscopic ACD followed by fusion in which a carbon fiber cage (see Operative Technique ) was implanted. One day preoperatively, 1 day postoperatively

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Umberto Agrillo, Luciano Mastronardi and Fabrizio Puzzilli

plating: analysis of results and review of the literature. Surg Neurol 49: 25–31, 1998 3. Brantigan JW , Steffee AD , Geiger JM : A carbon fiber implant to aid interbody fusion. Mechanical testing. Spine 16 : S277 – S282 , 1991 Brantigan JW, Steffee AD, Geiger JM: A carbon fiber implant to aid interbody fusion. Mechanical testing. Spine 16: S277–S282, 1991 4. Brooke NS , Rorke AW , King AT , et al : Preliminary experience of carbon fibre cage prostheses for treatment of cervical spine

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Khalil Salame, Georges E. R. Ouaknine, Nissim Razon and Semion Rochkind

Object

Cage devices were introduced in spinal fusion to overcome the shortcomings of autograft, allograft, and biocompatible implants. The aim of this study was to assess the short-term results of anterior cervical discectomy and fusion (ACDF) in which an interbody carbon fiber cage (CFC) and local osteophyte–derived bone graft were implanted.

Methods

A retrospective review was conducted of 100 consecutive patients treated by ACDF in which a CFC was packed with bone fragments obtained from osteophytes at the surgical site. Plain radiographs with dynamic lateral views obtained 1 year postoperatively were used to assess bone fusion, alignment of the cervical spine, and stability. Dynamic radiographs were also obtained at last follow up to determine whether loss of cervical alignment or collapse at the fused disc had occurred.

The mean follow-up period was 25 months. In all cases the cervical lordosis was maintained or corrected to different extents and disc height was restored. Solid fusion was achieved in 98% of the cases. There were no cage-related complications and no cases of cage failure.

Conclusions

The authors conclude that application of the CFC for ACDF is safe, effective, and technically feasible. Osteophytes resected during surgery may be a good alternative material for bone grafting in cage-assisted cervical interbody fusion.

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Bhupal Chitnavis, Giuseppe Barbagallo, Richard Selway, Ronan Dardis, Ahmed Hussain and Richard Gullan

Object. The authors undertook a study to assess the value of posterior lumbar interbody fusion (PLIF) in which carbon fiber cages (CFCs) were placed in patients undergoing revision disc surgery for symptoms suggesting neural compression with low-back pain.

Methods. The authors followed their first 50 patients for a maximum of 5 years and a minimum of 6 months after implantation of the CFCs. Patients in whom magnetic resonance (MR) imaging demonstrated “simple” recurrent herniation did not undergo PLIF. Surgery was performed in patients with symptoms of neural root compression, tension signs, and back pain with focal disc degeneration and nerve root distortion depicted on MR imaging compatible with clinical signs and symptoms. In 40 patients (80%) pedicle screws were not used. Clinical outcome was assessed using the Prolo Functional Economic Outcome Rating scale. Fusion outcome was assessed using an established classification.

Symptoms in 46 patients (92%) improved after surgery, and given their outcomes, 45 (90%) would have undergone the same surgery again. Two thirds of patients experienced good or excellent outcomes (Prolo score ≥ 8) at early and late follow up. There was no difference in clinical outcome between those in whom pedicle screws were and were not implanted (p = 0.83, Mann—Whitney U-test). The fusion rate at 2 years postsurgery was 95%. There were minimal complications, and no patients fared worse after surgery. No patient has undergone additional surgical treratment of the fused intervertebral space.

Conclusions. In this difficult group of patients the aim remains to improve symptoms but not cure the disease. A high fusion rate is possible when using the CFCs. Clinical success depends on selecting patients in whom radiological and clinical criteria accord. Pedicle screws are not necessary if facet joints are preserved, and high fusion rates and clinical success are possible without them.

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Frédéric Schils, Benedict Rilliet and Michael Payer

implantation of a carbon fiber cage . J Neurosurg 95 : 1 Suppl 40 – 42 , 2001 5 Brooke NS , Rorke AW , King AT , Gullan RW : Preliminary experience of carbon fibre cage prostheses for treatment of cervical spine disorders . Br J Neurosurg 11 : 221 – 227 , 1997 6 Carette S , Fehlings MG : Cervical radiculopathy . N Engl J Med 353 : 392 – 399 , 2005 7 Cloward RB : The anterior approach for removal of ruptured cervical discs . J Neurosurg 15 : 602 – 617 , 1958 8 Dowd GC , Wirth FP : Anterior cervical, discectomy: is fusion

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Dennis J. Rivet, David Jeck, James Brennan, Adrian Epstein and Carl Lauryssen

. In addition, because uni- or bilateral TLIF is often performed in patients with a history of multiple surgeries and can be technically demanding, the incidence of complications has been significant. 5, 10, 13 In this prospective series of 42 patients, the authors report the outcomes and complications associated with LIF performed using carbon fiber cages and pedicle screw fixation by a single surgeon. Clinical Material and Methods Patient Population Forty-two consecutive patients were enrolled between February 1999 and July 2000. All patients provided

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Neurosurgical Forum: Letters to the Editor To The Editor Thomas B. Ducker , M.D. Annapolis, Maryland 114 114 Abstract: Object. The purposes of bone substitutes for anterior cervical fusion (ACF) are immediate biomechanical support and osteointegration of the graft. The authors report their preliminary results in performing ACF in which carbon fiber cages (CFCs) containing coralline hydroxyapatite (HA) are used as bone substitute. Methods. During a 24-month period, anterior microsurgical discectomy was

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Arien J. Smith, Marc Arginteanu, Frank Moore, Alfred Steinberger and Martin Camins

our initial practice, we used titanium spacers for our interbody fusions. However, these spacers were supplanted by carbon fiber cages because of the ability of the latter to more easily demonstrate radiographic fusion. We recently introduced bioabsorbable cages into our practice because we were attracted by the fact that, with these implants, no long-term foreign body is left in the disc space. In the present study, we prospectively examine and compare the fusion rates and the incidence of device-related complications in patients undergoing TLIF using implants

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Robert F. Heary, Naresh K. Parvathreddy, Zainab S. Qayumi, Naiim S. Ali and Nitin Agarwal

radiolucent carbon fiber and PEEK implants, such evaluations are limited when using radiopaque, or titanium, implants (given the artifacts produced by the titanium). 9 Diedrich et al. have indicated that with MRI analysis, it is possible to differentiate between atrophic tissue and bony fusion within PEEK and carbon fiber cages, while such differentiation is impossible within metal cages. 14 FIG. 6. Conventional radiograph, lateral view, showing CFRP cage implanted at the T-2 vertebral level. Morselized bone graft was packed into the cage prior to implantation

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Timothy C. Ryken, Robert F. Heary, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Langston T. Holly, Michael G. Kaiser, Praveen V. Mummaneni, Tanvir F. Choudhri, Edward J. Vresilovic and Daniel K. Resnick

may result in more settling and fragmentation (quality of evidence, Class III; strength of recommendation, D). Carbon fiber cages are recommended for arthrodesis after ACDF with fusion rates > 50% (quality of evidence, Class III; strength of recommendation, D). The use of PMMA is not recommended as a means to preserve interspace height after anterior discectomy. Although short-term results are similar to those obtained with bone grafts, fusion generally does not occur when PMMA is used as a spacer, and the long-term consequences have not been described (quality of