Skip to main content

Advertisement

Log in

A prospective clinical comparison of rectangular titanium cages and iliac crest autografts in anterior cervical discectomy and fusion

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

The complications of autogenous bone grafting cause spinal surgeons to seek alternative methods for cervical spinal fusion. This prospective study was conducted to evaluate the safety and efficacy of rectangular titanium cages as compared to the widely performed iliac crest autograft fusion. Thirty-six patients with cervical disc disease in whom an anterior cervical approach was indicated for discectomy were included in a prospective controlled study protocol with 1-year follow-up. The first 18 consecutive patients received iliac crest autograft, while the next 18 received rectangular titanium cages. According to Odom's criteria, 15 of 18 (83%) patients in both groups experienced good to excellent functional recovery. According to the patient satisfaction index, 17 of 18 (94%) in both groups were satisfied. There were no significant differences in neck or arm pain. Fusion was present after 1 year in 16 of 18 (89%) patients in the iliac crest autograft group and 15 of 18 (83%) in the rectangular titanium cage group. In the autograft group, one case of pseudarthrosis was present, and marked hip pain was observed in four patients. There were no implant-related complications in the cage group. The authors conclude that titanium cages in anterior cervical discectomy constitute a safe and efficient alternative to iliac crest bone autograft.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.
Fig. 6.
Fig. 7.
Fig. 8.

Similar content being viewed by others

References

  1. Abd-Alrahman N, Dokmak AS, Abou-Madawi A (1999) Anterior cervical discectomy (ACD) versus anterior cervical fusion (ACF), clinical and radiological outcome study. Acta Neurochir (Wien) 141:1089–1092

    Google Scholar 

  2. Agrillo U, Mastronardi L, Puzzilli F (2002) Anterior cervical fusion with carbon fiber cage containing coralline hydroxyapatite: preliminary observations in 45 consecutive cases of soft-disc herniation. J Neurosurg 96:273–276

    CAS  PubMed  Google Scholar 

  3. Al-Hami S (1999) Cervical monosegmental interbody fusion using titanium implants in degenerative, intervertebral disc disease. Minim Invasive Neurosurg 42:10–17

    CAS  PubMed  Google Scholar 

  4. An HS, Simpson JM, Glover JM, Stephany J (1995) Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study. Spine 20:2211–2216

    CAS  PubMed  Google Scholar 

  5. Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine 20:1055–1060

    CAS  PubMed  Google Scholar 

  6. Bartels RH, Donk R, van Azn RD (2001) Height of cervical foramina after anterior discectomy and implantation of a carbon fiber cage. J Neurosurg 95:40–42

    Article  CAS  PubMed  Google Scholar 

  7. Bertalanffy H, Eggert HR (1988) Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir (Wien) 90:127–135

    Google Scholar 

  8. 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

    CAS  PubMed  Google Scholar 

  9. Boker DK, Schultheiss R, van Roost D, Osborn JF, Kaden B (1993) Anterior cervical discectomy and vertebral interbody fusion with hydroxy-apatite ceramic. Preliminary results. Acta Neurochir (Wien) 121:191–195

    Google Scholar 

  10. Cannada LK, Scherping SC, Yoo JU, Jones PK, Emery SE (2003) Pseudoarthrosis of the cervical spine: a comparison of radiographic diagnostic measures. Spine 28:46–51

    Article  PubMed  Google Scholar 

  11. Carvi y Nievas MN, Pöllath A, Haas E, Höllerhage HG (2000) Cervical discectomy: bone graft or cage fusion? A comparison study. In: Brock M, Schwarz W, Wille C (eds) First Interdisciplinary World Congress on Spinal Surgery and Related Disciplines. Monduzzi, Bologna, pp 123–128

  12. Caspar W, Geisler FH, Pitzen T, Johnson TA (1998) Anterior cervical plate stabilization in one- and two-level degenerative disease: overtreatment or benefit? J Spinal Disord 11:1–11

    Google Scholar 

  13. Cloward RB (1958) The anterior approach for removal of ruptured cervical discs. J Neurosurg 15:602–616

    CAS  Google Scholar 

  14. Daltroy LH, Cats-Baril WL, Katz JN, Fossel AH, Liang MH (1996) The North American Spine Society lumbar spine outcome assessment instrument: reliability and validity tests. Spine 21:741–749

    CAS  PubMed  Google Scholar 

  15. Dowd GC, Wirth FP (1999) Anterior cervical discectomy: is fusion necessary? J Neurosurg 90:8–12

    Google Scholar 

  16. Farahani K, Sinha U, Sinha S, Chiu LC, Lufkin RB (1990) Effect of field strength on susceptibility artifacts in magnetic resonance imaging. Comput Med Imaging Graph 14:409–413

    CAS  PubMed  Google Scholar 

  17. Furderer S, Schollhuber F, Rompe JD, Eysel P (2002) Effect of design and implantation technique on risk of progressive sintering of various cervical vertebrae cages [German]. Orthopade 31:466–471

    Google Scholar 

  18. Hacker RJ, Cauthen JC, Gilbert TJ, Griffith SL (2000) A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25:2646–2654

    Article  CAS  PubMed  Google Scholar 

  19. Hafez RF, Crockard HA (1997) Failure of osseous conduction with cervical interbody BOP graft. Br J Neurosurg 11:57–59

    Article  CAS  PubMed  Google Scholar 

  20. Hamburger C, Festenberg FV, Uhl E (2001) Ventral discectomy with PMMA interbody fusion for cervical disc disease: long-term results in 249 patients. Spine 26:249–255

    Article  CAS  PubMed  Google Scholar 

  21. Heary RF, Schlenk RP, Sacchieri TA, Barone D, Brotea C (2002) Persistent iliac crest donor site pain: independent outcome assessment. Neurosurgery 50:510–516

    PubMed  Google Scholar 

  22. Ibanez J, Carreno A, Garcia-Amorena C, Caral J, Gaston F, Ferrer E (1998) Results of the biocompatible osteoconductive polymer (BOP) as an intersomatic graft in anterior cervical surgery. Acta Neurochir (Wien) 140:126–133

    Google Scholar 

  23. Lange M, Philipp A, Fink U, Oeckler R (2000) Anterior cervical spine fusion using RABEA-Titan-Cages avoiding iliac crest spongiosa: first experiences and results. Neurol Neurochir Pol 34:64–69

    CAS  PubMed  Google Scholar 

  24. Lozes G, Fawaz A, Cama A, Krivosic I, Devos P, Herlant M, Sertl GO, Clarisse J, Jomin M (1989) Discectomies of the lower cervical spine using interbody biopolymer (B.O.P.) implants. Advantages in the treatment of complicated cervical arthrosis. A review of 150 cases. Acta Neurochir (Wien) 96:88–93

    Google Scholar 

  25. Madawi AA, Powell M, Crockard HA (1996) Biocompatible osteoconductive polymer versus iliac graft. A prospective comparative study for the evaluation of fusion pattern after anterior cervical discectomy. Spine 21:2123–2129

    Article  CAS  PubMed  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100

    CAS  PubMed  Google Scholar 

  28. Odom GL, Finney W, Woodhall B (1958) Cervical disc lesions. JAMA 166:23–28

    CAS  Google Scholar 

  29. Palit M, Schofferman J, Goldthwaite N, Reynolds J, Kerner M, Keaney D, Lawrence-Miyasaki L (1999) Anterior discectomy and fusion for the management of neck pain. Spine 24:2224–2228

    Article  CAS  PubMed  Google Scholar 

  30. Profeta G, de Falco R, Ianniciello G, Profeta L, Cigliano A, Raja AI (2000) Preliminary experience with anterior cervical microdiscectomy and interbody titanium cage fusion (Novus CT-Ti) in patients with cervical disc disease. Surg Neurol 53:417–426

    Article  CAS  PubMed  Google Scholar 

  31. Robinson RA, Walker AE, Ferlic DC (1962) The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg Am 44:1569–1587

    Google Scholar 

  32. Savolainen S, Rinne J, Hernesniemi J (1998) A prospective randomized study of anterior single-level cervical disc operations with long-term follow-up: surgical fusion is unnecessary. Neurosurgery 43:51–55

    CAS  PubMed  Google Scholar 

  33. Sawin PD, Traynelis VC, Menezes AH (1998) A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions. J Neurosurg 88:255–265

    CAS  PubMed  Google Scholar 

  34. Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2:175–184

    CAS  PubMed  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 AW, Robinson RA (1958) The treatment of certain spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40:607–624

    Google Scholar 

  37. Sonntag VK, Klara P (1996) Controversy in spine care. Is fusion necessary after anterior cervical discectomy? Spine 21:1111–1113

    Google Scholar 

  38. Tartaglino LM, Flanders AE, Vinitski S, Friedman DP (1994) Metallic artifacts on MR images of the postoperative spine: reduction with fast spin-echo techniques. Radiology 190:565–569

    CAS  PubMed  Google Scholar 

  39. Thalgott JS, Fritts K, Giuffre JM, Timlin M (1999) Anterior interbody fusion of the cervical spine with coralline hydroxyapatite. Spine 24:1295–1299

    Article  CAS  PubMed  Google Scholar 

  40. Thorell W, Cooper J, Hellbusch L, Leibrock L (1998) The long-term clinical outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement. Neurosurgery 43:268–273

    CAS  PubMed  Google Scholar 

  41. van den Bent MJ, Oosting J, Wouda EJ, van Acker EH, Ansink BJ, Braakman R (1996) Anterior cervical discectomy with or without fusion with acrylate. A randomized trial. Spine 21:834–839

    Article  PubMed  Google Scholar 

  42. Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A (2002) A prospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine 27:1694–1701

    Article  PubMed  Google Scholar 

  43. Wang GJ, Reger SI, Shao ZH, Morton CL, Stamp WG (1984) Comparative strength of anterior spinal fixation with bone graft or polymethylmethacrylate. Experimental operations and observations on dogs. Clin Orthop 188:303–308

    CAS  PubMed  Google Scholar 

  44. Watters WC III, Levinthal R (1994) Anterior cervical discectomy with and without fusion. Results, complications, and long-term follow-up. Spine 19:2343–2347

    PubMed  Google Scholar 

  45. Whitehill R, Barry JC (1985) The evolution of stability in cervical spinal constructs using either autogenous bone graft or methylmethacrylate cement. A follow-up report on a canine in vivo model. Spine 10:32–41

    CAS  PubMed  Google Scholar 

  46. 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

    Google Scholar 

  47. Wilke HJ, Kettler A, Goetz C, Claes L (2000) Subsidence resulting from simulated postoperative neck movements: an in vitro investigation with a new cervical fusion cage. Spine 25:2762–2770

    Article  CAS  PubMed  Google Scholar 

  48. Wilson DH, Campbell DD (1977) Anterior cervical discectomy without bone graft. Report of 71 cases. J Neurosurg 47:551–555

    CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Claudius Thomé.

Additional information

The authors have no financial interest in the instrumentation or methodology advanced in this manuscript

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomé, C., Krauss, J.K. & Zevgaridis, D. A prospective clinical comparison of rectangular titanium cages and iliac crest autografts in anterior cervical discectomy and fusion. Neurosurg Rev 27, 34–41 (2004). https://doi.org/10.1007/s10143-003-0297-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-003-0297-2

Keywords

Navigation