Feasibility of local bone dust as a graft material in anterior cervical discectomy and fusion

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OBJECTIVE

Local bone dust has been used previously as a substitute cage filling material for iliac bone grafts during anterior cervical discectomy and fusion (ACDF). However, the impacts of local bone dust on fusion rate and clinical results remain unclear. Extragraft bone bridging (ExGBB) is a reliable CT finding indicating segmental fusion. This study was conducted to compare fusion rates for the use of local bone dust or an iliac auto bone graft during ACDF surgery and to evaluate the effect of implanting bone graft outside the cage.

METHODS

Ninety-three patients who underwent ACDF at a single institution were included. An iliac bone graft was used as the polyetheretherketone (PEEK) cage filling graft material in 43 patients (iliac crest [IC] group). In the IC group, bone graft material was inserted only inside the cage. Local bone dust was used in 50 patients (local bone [LB] group). Bone graft material was inserted both inside and outside the cage in the LB group. Segmental fusion was assessed by 1) interspinous motion (ISM), 2) intragraft bone bridging (InGBB), and 3) ExGBB. Fusion rates, visual analog scale (VAS) scores for neck and arm pain, and Neck Disability Index (NDI) scores were compared between the 2 groups.

RESULTS

The neck and arm pain VAS scores and NDI score improved significantly in both groups. Fusion rates assessed by ISM and InGBB did not differ significantly between the groups. However, the fusion rate in the LB group was significantly higher than that in the IC group when assessed by ExGBB (p = 0.02).

CONCLUSIONS

Using local bone dust as cage filling material resulted in fusion rates similar to those for an iliac bone graft, while avoiding potential complications and pain caused by iliac bone harvesting. A higher rate of extragraft bone bridge formation was achieved by implanting local bone dust outside the cage.

ABBREVIATIONS ACDF = anterior cervical discectomy and fusion; DBM = demineralized bone matrix; ExGBB = extragraft bone bridging; IC = iliac crest; ICC = interclass correlation coefficient; InGBB = intragraft bone bridging; ISM = interspinous motion; LB = local bone; NDI = Neck Disability Index; PEEK = polyetheretherketone; VAS = visual analog scale.

Article Information

Correspondence Dong-Ho Lee: Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. osdlee@gmail.com.

INCLUDE WHEN CITING Published online June 7, 2019; DOI: 10.3171/2019.3.SPINE181416.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Intragraft bone bridge formation (red arrows) on the 1-year postoperative CT scan of a 58-year-old male patient who underwent ACDF at C4–5 due to cervical myelopathy. Figure is available in color online only.

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    Extragraft bone bridge formation (red arrows) on the 1-year postoperative CT scan of a 51-year-old male patient who underwent ACDF at C5–6 due to cervical radiculopathy. Figure is available in color online only.

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    Implantation of local bone dust outside the cage during ACDF surgery in a 45-year-old female patient. She had ACDF C5–6 due to cervical myelopathy caused by spondylosis. Figure is available in color online only.

References

  • 1

    Ba ZZhao WWu DShen BYu BWang Z: Box cages packed with local decompression bone were efficient in anterior cervical discectomy and fusion: five- to 10-year follow-up. Spine (Phila Pa 1976) 37:E1260E12632012

    • Search Google Scholar
    • Export Citation
  • 2

    Carreon LYDjurasovic MGlassman SDSailer P: Diagnostic accuracy and reliability of fine-cut CT scans with reconstructions to determine the status of an instrumented posterolateral fusion with surgical exploration as reference standard. Spine (Phila Pa 1976) 32:8928952007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Carreon LYGlassman SDSchwender JDSubach BRGornet MFOhno S: Reliability and accuracy of fine-cut computed tomography scans to determine the status of anterior interbody fusions with metallic cages. Spine J 8:99810022008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Hacker RJCauthen JCGilbert TJGriffith SL: A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine (Phila Pa 1976) 25:264626552000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Jacobs WWillems PCvan Limbeek JBartels RPavlov PAnderson PG: Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev (1):CD0049582011

    • Search Google Scholar
    • Export Citation
  • 6

    Kaiser MGHaid RW JrSubach BRBarnes BRodts GE Jr: Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:2292382002

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Lee DHCho JHBaik JMJoo YSPark SMin WK: Does additional uncinate resection increase pseudarthrosis following anterior cervical discectomy and fusion? Spine (Phila Pa 1976) 43:971042018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Lied BRoenning PASundseth JHelseth E: 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). BMC Surg 10:102010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Liu JMXiong XPeng AFXu MChen XYLong XH: A comparison of local bone graft with PEEK cage versus iliac bone graft used in anterior cervical discectomy and fusion. Clin Neurol Neurosurg 155:30352017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Min WKBae JSPark BCJeon IHJin HKSon MJ: Proliferation and osteoblastic differentiation of bone marrow stem cells: comparison of vertebral body and iliac crest. Eur Spine J 19:175317602010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Missiuna PCGandhi HSFarrokhyar FHarnett BEDore EMRoberts B: Anatomically safe and minimally invasive transcrestal technique for procurement of autogenous cancellous bone graft from the mid-iliac crest. Can J Surg 54:3273322011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Papavero LZwönitzer RBurkard IKlose KHerrmann HD: A composite bone graft substitute for anterior cervical fusion: assessment of osseointegration by quantitative computed tomography. Spine (Phila Pa 1976) 27:103710432002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Park JICho DCKim KTSung JK: Anterior cervical discectomy and fusion using a stand-alone polyetheretherketone cage packed with local autobone: assessment of bone fusion and subsidence. J Korean Neurosurg Soc 54:1891932013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Peelle MWRawlins BAFrelinghuysen P: A novel source of cancellous autograft for ACDF surgery: the manubrium. J Spinal Disord Tech 20:36412007

  • 15

    Riachi FNaaman NTabarani CBerberi ASalameh Z: Comparison of morbidity and complications of harvesting bone from the iliac crest and calvarium: a retrospective study. J Int Oral Health 6:32352014

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Schils FRilliet BPayer M: Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study. J Neurosurg Spine 4:2922992006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Shad ALeach JCTeddy PJCadoux-Hudson TA: Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience. J Neurosurg Spine 2:1161222005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Silber JSAnderson DGDaffner SDBrislin BTLeland JMHilibrand AS: Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 28:1341392003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Smith GWRobinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A:6076241958

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Song KJYoon SJLee KB: Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct. Eur Spine J 21:249224972012

  • 21

    Song KSChaiwat PKim HJMesfin APark SMRiew KD: Anterior cervical fusion assessment using reconstructed computed tomographic scans: surgical confirmation of 254 segments. Spine (Phila Pa 1976) 38:217121772013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Song KSPiyaskulkaew CChuntarapas TBuchowski JMKim HJPark MS: Dynamic radiographic criteria for detecting pseudarthrosis following anterior cervical arthrodesis. J Bone Joint Surg Am 96:5575632014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Yang JJYu CHChang BSYeom JSLee JHLee CK: Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage. Clin Orthop Surg 3:16232011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

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