Comparison of the effectiveness and safety of bioactive glass ceramic to allograft bone for anterior cervical discectomy and fusion with anterior plate fixation
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Recently, a bioactive glass ceramic (BGC) has been developed for use as intervertebral cages for anterior cervical discectomy and fusion (ACDF). However, the effectiveness and safety of BGC cages remain to be evaluated. We completed a retrospective comparison of the radiological and clinical outcomes of 36 patients (52 levels) who underwent ACDF with a BGC cage and 35 patients (54 levels) using allograft bone. The following variables were compared between the two groups: the visual analog (VAS) neck and arm pain score and the neck disability index (NDI), measured before surgery and 1 year after; the change in Cobb’s angle, between the C2 and C7 vertebrae, the global sagittal angle, and disc height compared from before surgery to 1 year after; and the rate of spinal fusion and cage subsidence at 1 and 2 years after surgery. The VAS and NDI scores were not different between the two groups. Similarly, the spinal fusion rate was not different between the BGC and allograft bone group at 1 year (73% and 87%, respectively; p = 0.07) and 2 years (94% and 91%, respectively; p = 0.54) after surgery. However, the rate of cage subsidence was higher in the allograft bone (43%) than the BGC (19%) group (p = 0.03), as was the rate of instrument-related failure (p = 0.028), with a specifically higher incidence of implant fracture or failure in the allograft bone group (p = 0.025). Overall, our findings indicate that BGC cages provide a feasible and safe alternative to allograft bone for ACDF.
KeywordsAnterior cervical discectomy and fusion Bioactive glass ceramic cage Allograft bone Fusion rate Clinical and radiological outcomes
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures were performed in accordance with the ethical standards of the Institutional Review Board of Severance Hospital (approval number 2019-0739-001).
The requirement for informed consent was waived because of the retrospective design of this study.
- 4.Börm W, Seitz K (2004) Use of cervical stand-alone cages. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 13:474–475 author reply 476 Google Scholar
- 5.Chen Y, Lu G, Wang B, Li L, Kuang L (2016) A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up. Eur Spine J 25:2255–2262PubMedCrossRefPubMedCentralGoogle Scholar
- 8.Diebo BG, Oren JH, Challier V, Lafage R, Ferrero E, Liu S, Vira S, Spiegel MA, Harris BY, Liabaud B, Henry JK, Errico TJ, Schwab FJ, Lafage V (2016) Global sagittal axis: a step toward full-body assessment of sagittal plane deformity in the human body. J Neurosurg Spine 25:494–499PubMedCrossRefPubMedCentralGoogle Scholar
- 13.Haws BE, Khechen B, Patel DV, Yoo JS, Guntin JA, Cardinal KL, Singh K (2019) Swallowing function following anterior cervical discectomy and fusion with and without anterior plating: a SWAL-QOL (Swallowing-Quality of Life) and Radiographic Assessment. Neurospine 16:601–607PubMedPubMedCentralCrossRefGoogle Scholar
- 14.Heidt ST, Louie PK-H, Khan JM, Basques BA, Hirsch B, Varthi A, Paul JC, Goldberg EJ, An HS (2019) Comparing allografts to autografts for maintenance of cervical sagittal parameters and clinical outcomes following anterior cervical discectomy and fusion with anterior cervical plating. Neurospine 16:618–625PubMedPubMedCentralCrossRefGoogle Scholar
- 18.Jae Hyup L, Ul Oh J, Do Hwan J, Bong Soon C, Choon Ki L (2010) Quantitative comparison of novel CaO-SiO2-P2O5-B2O3 glass-ceramics (BGS-7) with hydroxyapatite as bone graft extender in rabbit ilium. Korean Tissue Engineering and Regenerative Medicine 7:540–547Google Scholar
- 20.Jiya T, Smit T, Deddens J, Mullender M (2009) Posterior lumbar interbody fusion using nonresorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D,L-lactide fusion devices: a prospective, randomized study to assess fusion and clinical outcome. Spine (Phila Pa 1976) 34:233–237CrossRefGoogle Scholar
- 21.Kim DH, Lee C-H, Ko YS, Yang SH, Kim CH, Park SB, Chung CK (2019) The clinical implications and complications of anterior versus posterior surgery for multilevel cervical ossification of the posterior longitudinal ligament; an updated systematic review and meta-analysis. Neurospine 16:530–541PubMedPubMedCentralCrossRefGoogle Scholar
- 22.Kim Y, Lim JY, Yang GH, Seo J-H, Ryu H-S, Kim G (2019) 3D-printed PCL/bioglass (BGS-7) composite scaffolds with high toughness and cell-responses for bone tissue regeneration. J Ind Eng ChemGoogle Scholar
- 24.Koo K, Hwang C, Lee JH, Chang B-S, Lee C-K (2009) Treatment of bone defects in rabbit tibiae using CaO-SiO2-P2O5-B2O3 bioactive ceramics: radiological, biomechanical, and histological evaluationGoogle Scholar
- 33.Lied B, Roenning PA, Sundseth J, Helseth E (2010) 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 10:10PubMedPubMedCentralCrossRefGoogle Scholar
- 42.Ryken TC, Heary RF, Matz PG, Anderson PA, Groff MW, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Vresilovic EJ, Resnick DK, Joint Section on Disorders of the S, Peripheral Nerves of the American Association of Neurological S, Congress of Neurological S (2009) Techniques for cervical interbody grafting. J Neurosurg Spine 11:203–220Google Scholar
- 47.Siambanes D, Mather S (1998) Comparison of plain radiographs and CT scans in instrumented posterior lumbar interbody fusionGoogle Scholar