Is “mini-invasive” technique for iliac crest harvesting an alternative to cervical cage implant? An overview of a large personal experience

Background: Autograft bone provides an excellent substrate for multilevel arthrodesis after anterior discectomy and is inexpensive. However, the use of tricortical bone could increase the discomfort for the patient. Methods: We reviewed cases of cervical disc diseases operated on by a single neurosurgeon (AS), within the period June 2000-December 2011. A total of 221 patients were considered for the present study; 109 female, 112 male, averaging 49 years of age. Only patients who could be followed up for at least one year were included in the present study. The grafts obtained with the technique described are bi- (and not tri-) cortical, and always of sufficient size in order to fit two spaces if necessary. Results: The technique is not associated with long-term significant donor site pain except for a striking minority of patients, it shortens the hospital stay, it offers comparable results to the published surgical series in which cage and/or modern implants are used. Conclusions: Autograft bone can be reasonably considered as one of the possible alternatives to be used in the surgical management of cervical disk disease.

[1]  A. Abbott,et al.  Is there a need for cervical collar usage post anterior cervical decompression and fusion using interbody cages? A randomized controlled pilot trial , 2013, Physiotherapy theory and practice.

[2]  P. Korovessis,et al.  Cervical spondylodiscitis associated with oesophageal perforation: a rare complication after anterior cervical fusion , 2013, European Journal of Orthopaedic Surgery & Traumatology.

[3]  Caleb J. Behrend,et al.  Smoking Cessation Related to Improved Patient-Reported Pain Scores Following Spinal Care. , 2012, The Journal of bone and joint surgery. American volume.

[4]  G. Ramieri,et al.  Morbidity associated with anterior iliac crest bone graft. , 2012, Oral surgery, oral medicine, oral pathology and oral radiology.

[5]  M. Bosse,et al.  Prospective observational study of donor-site morbidity following anterior iliac crest bone-grafting in orthopaedic trauma reconstruction patients. , 2012, The Journal of bone and joint surgery. American volume.

[6]  N. Tran,et al.  Biomechanical comparison of anterior cervical spine instrumentation techniques with and without supplemental posterior fusion after different corpectomy and discectomy combinations: Laboratory investigation. , 2012, Journal of neurosurgery. Spine.

[7]  D. Hood,et al.  Reducing the Cost and Frequency of Explantations Associated With Single-Level Anterior Diskectomy and Fusion at a Single Institution Through Education , 2012, Spine.

[8]  R. Shah,et al.  Anterior cervical microdiscectomy: is bone grafting and in-situ fusion with instrumentation required? , 2012, British journal of neurosurgery.

[9]  B. Koes,et al.  Open Access STUDY PROTOCOL , 2010 .

[10]  E. Helseth,et al.  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) , 2010, BMC surgery.

[11]  N. Crawford,et al.  A New Stand-Alone Cervical Anterior Interbody Fusion Device: Biomechanical Comparison With Established Anterior Cervical Fixation Devices , 2009, Spine.

[12]  M. Kosteljanetz,et al.  Anterior Cervical Discectomy With or Without Fusion With Ray Titanium Cage: A Prospective Randomized Clinical Study , 2008, Spine.

[13]  M. Akula,et al.  The Plate Cage Benezech implant as an alternative to autologous bone graft in the treatment of cervical spondylosis: clinical and functional outcome , 2008, British journal of neurosurgery.

[14]  B. Lind,et al.  Autograft versus interbody fusion cage without plate fixation in the cervical spine: a randomized clinical study using radiostereometry , 2007, European Spine Journal.

[15]  A. Spallone A less-invasive technique for harvesting autologous iliac crest grafts for cervical interbody fusion: technical note. , 2007, Surgical neurology.

[16]  J. Goffin,et al.  Clinical Significance of Heterotopic Ossification in Cervical Disc Replacement: A Prospective Multicenter Clinical Trial , 2005, Neurosurgery.

[17]  Edward J. Goldberg,et al.  Is Autograft the Gold Standard in Achieving Radiographic Fusion in One-Level Anterior Cervical Discectomy and Fusion With Rigid Anterior Plate Fixation? , 2005, Spine.

[18]  C. Shaffrey,et al.  Iliac Crest Bone Graft Donor Site Pain After Anterior Lumbar Interbody Fusion: A Prospective Patient Satisfaction Outcome Assessment , 2005, Journal of spinal disorders & techniques.

[19]  J. Sénégas,et al.  Anterior discectomy without interbody fusion for cervical disc herniation , 2004, European Spine Journal.

[20]  E. Tessitore,et al.  Implantation of an empty carbon fiber composite frame cage after single-level anterior cervical discectomy in the treatment of cervical disc herniation: preliminary results. , 2003, Journal of neurosurgery.

[21]  W. Bingaman,et al.  Preliminary experience with the DOC dynamic cervical implant for the treatment of multilevel cervical spondylosis. , 2002, Journal of neurosurgery.

[22]  B. Subach,et al.  Anterior Cervical Plating Enhances Arthrodesis after Discectomy and Fusion with Cortical Allograft , 2002, Neurosurgery.

[23]  J. van Limbeek,et al.  A systematic literature review to identify the best method for a single level anterior cervical interbody fusion , 2000, European Spine Journal.

[24]  M. Macmillan,et al.  Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review. , 1999, Spine.

[25]  F. P. Wirth,et al.  Anterior cervical discectomy: is fusion necessary? , 1999, Journal of neurosurgery.

[26]  B. Bose,et al.  Anterior cervical fusion using Caspar plating: analysis of results and review of the literature. , 1998, Surgical neurology.

[27]  D. Bradford,et al.  The use of bone allografts in the spine. , 1996, Clinical orthopaedics and related research.

[28]  V. Sonntag,et al.  Controversy in spine care. Is fusion necessary after anterior cervical discectomy? , 1996, Spine.

[29]  R E Booth,et al.  Harvesting Autogenous Iliac Bone Grafts: A Review of Complications and Techniques , 1989, Spine.

[30]  D. Prolo,et al.  Toward Uniformity in Evaluating Results of Lumbar Spine Operations: A Paradigm Applied to Posterior Lumbar Interbody Fusions , 1986, Spine.

[31]  L. Riley,et al.  Results of anterior interbody fusion of the cervical spine. , 1968, Clinical orthopaedics and related research.

[32]  R. Robinson,et al.  The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. , 1958, The Journal of bone and joint surgery. American volume.