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Comparison of the biomechanical stability of dense cancellous allograft with tricortical iliac autograft and fibular allograft for cervical interbody fusion

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An Erratum to this article was published on 07 June 2006

Abstract

Several choices are available for cervical interbody fusion after anterior cervical discectomy. A recent option is dense cancellous allograft (CS) which is characterized by an open-matrix structure that may promote vascularization and cellular penetration during early osseous integration. However, the biomechanical stability of CS should be comparable to that of the tricortical iliac autograft (AG) and fibular allograft (FA) to be an acceptable alternative to these materials. The purpose of this study was to compare the initial biomechanical stability of CS to that of AG and FA in a one-level anterior cervical discectomy and interbody fusion (ACDF) model. Twelve human cervical spines (C3–T1) were loaded in six modes of motion and evaluated under three conditions: (1) intact, (2) after ACDF using CS, AG, and FA in alternating sequences, and (3) after ACDF with anterior plating. Three reflective markers were placed on the adjacent vertebral bodies. Intervertebral motion was measured with a video-based motion-capture system (MacReflex, Qualisys, Sweden). Torques were applied to a maximum of 2.0 N m. The range-of-motion and neutral-zone values measured in each loading mode were compared. No graft material displayed significant differences in biomechanical stability in any of the tested loading modes, suggesting that the initial stability of CS is comparable to that of AG and FA. Anterior cervical plating significantly increased biomechanical stability in all modes.

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Abbreviations

ACDF:

Anterior cervical discectomy and interbody fusion

AG:

Tricortical iliac autograft

AGP:

ACDF with AG followed by application of an anterior cervical plate

CS:

Dense cancellous allograft cervical spacer

CSP:

ACDF with CS followed by application of an anterior cervical plate

FA:

Freeze-dried fibular allograft

FAP:

ACDF with FA followed by application of an anterior cervical plate

NZ:

Neutral zone

ROM:

Range of motion

SD:

Standard deviation

References

  1. Alvarez JA, Hardy RW Jr (1999) Anterior cervical discectomy for one- and two-level cervical disc disease: the controversy surrounding the question of whether to fuse, plate, or both. Crit Rev Neurosurg 9:234–251

    Article  PubMed  Google Scholar 

  2. Balabhadra RSV, Kim DK, Zhang HY (2004) Anterior cervical fusion using dense cancellous allografts and dynamic plating. Neurosurgery 54:1405–1411

    Article  PubMed  Google Scholar 

  3. Bishop RC, Moore KA, Hadley MN (1996) Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate: a prospective comparative analysis. J Neurosurg 85:206–210

    PubMed  CAS  Google Scholar 

  4. Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75:1298–1307

    PubMed  CAS  Google Scholar 

  5. Brodke DS, Zdeblick TA (1992) Modified Smith–Robinson procedure for anterior cervical discectomy and fusion. Spine 17:S427–S430

    Article  PubMed  CAS  Google Scholar 

  6. Buttermann GR, Glazer PA, Bradford DS (1996) The use of bone allografts in the spine. Clin Orthop 324:75–85

    Article  PubMed  Google Scholar 

  7. Cauthen JC, Kinard RE, Vogler JB, Jackson DE, DePaz OB, Hunter OL, Wasserburger LB, Williams VM (1998) Outcome analysis of noninstrumented anterior cervical discectomy and interbody fusion in 348 patients. Spine 23:188–192

    Article  PubMed  CAS  Google Scholar 

  8. Cherry C (2002) Anterior cervical discectomy and fusion for cervical disc disease. Aorn J 76:998–1004, 1007, 1008; quiz 1009–1012

    Google Scholar 

  9. Connolly PJ, Esses SI, Kostuik JP (1996) Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates. J Spinal Disord 9:202–206

    PubMed  CAS  Google Scholar 

  10. DePalma AF, Rothman RH, Lewinnek GE, Canale ST (1972) Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet 134:755–758

    PubMed  CAS  Google Scholar 

  11. Emery SE, Bohlman HH, Bolesta MJ, Jones PK (1998) Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up. J Bone Joint Surg Am 80:941–951

    Article  PubMed  CAS  Google Scholar 

  12. Geer CP, Papadopoulos SM (1999) The argument for single-level anterior cervical discectomy and fusion with anterior plate fixation. Clin Neurosurg 45:25–29; discussion 21

    Google Scholar 

  13. Goel VK, Clausen JD (1998) Prediction of load sharing among spinal components of a C5–C6 motion segment using the finite element approach. Spine 23:684–691

    Article  PubMed  CAS  Google Scholar 

  14. Heidecke V, Rainov NG, Burkert W (1998) Anterior cervical fusion with the Orion locking plate system. Spine 23:1796–1802; discussion 1803

    Google Scholar 

  15. Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr (2002) Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:229–236; discussion 236–238

    Google Scholar 

  16. Kandziora F, Pflugmacher R, Schafer J, Born C, Duda G, Haas NP, Mittlmeier T (2001) Biomechanical comparison of cervical spine interbody fusion cages. Spine 26:1850–1857

    Article  PubMed  CAS  Google Scholar 

  17. Katsuura A, Hukuda S, Imanaka T, Miyamoto K, Kanemoto M (1996) Anterior cervical plate used in degenerative disease can maintain cervical lordosis. J Spinal Disord 9:470–476

    Article  PubMed  CAS  Google Scholar 

  18. Khan S, Sama A, Sandhu HS (2001) Bone graft substitutes in spine surgery. Curr Opin Orthpaedics 12:216–222

    Article  Google Scholar 

  19. Maciejczak A, Ciach M, Radek M Jr, Radek A, Awrejcewicz J (2001) Immediate stiffness of the C5–C6 segment after discectomy with the Cloward technique: an in vitro biomechanical study on a human cadaveric model. Neurosurgery 49:1399–1408

    Article  PubMed  CAS  Google Scholar 

  20. Malloy KM, Hilibrand AS (2002) Autograft versus allograft in degenerative cervical disease. Clin Orthop 394:27–38

    Article  PubMed  Google Scholar 

  21. Martin GJ Jr, Haid RW Jr, MacMillan M, Rodts GE Jr, Berkman R (1999) Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review. Spine 24:852–858; discussion 858–859

    Google Scholar 

  22. Mohr RA, Brodke DS (2005) Fixed versus dynamic cervical plates: how to choose the proper plate. Curr Opin Orthopaedics 16:194–199

    Article  Google Scholar 

  23. Natarajan RN, Chen BH, An HS, Andersson GB (2000) Anterior cervical fusion: a finite element model study on motion segment stability including the effect of osteoporosis. Spine 25:955–961

    Article  PubMed  CAS  Google Scholar 

  24. Olsewski JM, Garvey TA, Schendel MJ (1994) Biomechanical analysis of facet and graft loading in a Smith–Robinson type cervical spine model. Spine 19:2540–2544

    Article  PubMed  CAS  Google Scholar 

  25. Pelker RR, Friedlaender GE, Markham TC (1983) Biomechanical properties of bone allografts. Clin Orthop 174:54–57

    PubMed  Google Scholar 

  26. Pintar FA, Yoganandan N, Voo L (1998) Effect of age and loading rate on human cervical spine injury threshold. Spine 23:1957–1962

    Article  PubMed  CAS  Google Scholar 

  27. Portnoy HD (2001) Anterior cervical discectomy and fusion. Surg Neurol 56:178–180

    Article  PubMed  CAS  Google Scholar 

  28. Rapoff AJ, O’Brien TJ, Ghanayem AJ, Heisey DM, Zdeblick TA (1999) Anterior cervical graft and plate load sharing. J Spinal Disord 12:45–49

    PubMed  CAS  Google Scholar 

  29. Schnee CL, Freese A, Weil RJ, Marcotte PJ (1997) Analysis of harvest morbidity and radiographic outcome using autograft for anterior cervical fusion. Spine 22:2222–2227

    Article  PubMed  CAS  Google Scholar 

  30. Schulte K, Clark CR, Goel VK (1989) Kinematics of the cervical spine following discectomy and stabilization. Spine 14:1116–1121

    Article  PubMed  CAS  Google Scholar 

  31. Seiler JG III, Johnson J (2000) Iliac crest autogenous bone grafting:donor site complications. J South Orthop Assoc 9:91–97

    PubMed  Google Scholar 

  32. Shapiro S (1996) Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy. J Neurosurg 84:161–165

    Article  PubMed  CAS  Google Scholar 

  33. Shapiro S, Connolly P, Donnaldson J, Abel T (2001) Cadaveric fibula, locking plate, and allogeneic bone matrix for anterior cervical fusions after cervical discectomy for radiculopathy or myelopathy. J Neurosurg 95:43–50

    PubMed  CAS  Google Scholar 

  34. Shimamoto N, Cunningham BW, Dmitriev AE, Minami A, McAfee PC (2001) Biomechanical evaluation of stand-alone interbody fusion cages in the cervical spine. Spine 26:E432–E436

    Article  PubMed  CAS  Google Scholar 

  35. Silber JS, Anderson DG, Daffner SD, Brislin BT, Leland JM, Hilibrand AS, Vaccaro AR, Albert TJ (2003) Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 28:134–139

    Article  PubMed  Google Scholar 

  36. Smith MD, Cody DD (1993) Load-bearing capacity of corticocancellous bone grafts in the spine. J Bone Joint Surg Am 75:1206–1213

    PubMed  CAS  Google Scholar 

  37. Troyanovich SJ, Stroink AR, Kattner KA, Dornan WA, Gubina I (2002) Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions. J Spinal Disord Tech 15:69–74

    PubMed  Google Scholar 

  38. Vaccaro AR, Cirello J (2002) The use of allograft bone and cages in fractures of the cervical, thoracic, and lumbar spine. Clin Orthop 394:19–26

    Article  PubMed  Google Scholar 

  39. Wang JC, McDonough PW, Endow K, Kanim LE, Delamarter RB (1999) The effect of cervical plating on single-level anterior cervical discectomy and fusion. J Spinal Disord 12:467–471

    Article  PubMed  CAS  Google Scholar 

  40. White A III, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn. JB Lippincott-Raven, Philadelphia

    Google Scholar 

  41. Whitecloud TS III (1999) Modern alternatives and techniques for one-level discectomy and fusion. Clin Orthop 359:67–76

    Article  PubMed  Google Scholar 

  42. Wigfield CC, Nelson RJ (2001) Nonautologous interbody fusion materials in cervical spine surgery: how strong is the evidence to justify their use? Spine 26:687–694

    Article  PubMed  CAS  Google Scholar 

  43. Young WF, Rosenwasser RH (1993) An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy. Spine 18:1123–1124

    Article  PubMed  CAS  Google Scholar 

  44. Zdeblick TA, Ducker TB (1991) The use of freeze-dried allograft bone for anterior cervical fusions. Spine 16:726–729

    Article  PubMed  CAS  Google Scholar 

Download references

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Correspondence to Stephen I. Ryu.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00586-006-0146-4

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Ryu, S.I., Lim, J.T., Kim, SM. et al. Comparison of the biomechanical stability of dense cancellous allograft with tricortical iliac autograft and fibular allograft for cervical interbody fusion. Eur Spine J 15, 1339–1345 (2006). https://doi.org/10.1007/s00586-005-0047-y

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  • DOI: https://doi.org/10.1007/s00586-005-0047-y

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