0
selected
-
1.
Heterotopic ossification following single-level anterior cervical discectomy and fusion: results from the prospective, multicenter, historically controlled trial comparing allograft to an optimized dose of rhBMP-2.
Arnold, PM, Anderson, KK, Selim, A, Dryer, RF, Kenneth Burkus, J
Journal of neurosurgery. Spine. 2016;(3):292-302
Abstract
OBJECTIVE Heterotopic ossification (HO) has been reported following total hip, knee, cervical, and lumbar arthroplasty, as well as following posterolateral lumbar fusion using recombinant human bone morphogenetic protein-2 (rhBMP-2). Data regarding HO following anterior cervical discectomy and fusion (ACDF) with rhBMP-2 are sparse. A subanalysis was done of the prospective, multicenter, investigational device exemption trial that compared rhBMP-2 on an absorbable collagen sponge (ACS) versus allograft in ACDF for patients with symptomatic single-level cervical degenerative disc disease. METHODS To assess differences in types of HO observed in the treatment groups and effects of HO on functional and efficacy outcomes, clinical outcomes from previous disc replacement studies were compared between patients who received rhBMP-2/ACS versus allograft. Rate, location, grade, and size of ossifications were assessed preoperatively and at 24 months, and correlated with clinical outcomes. RESULTS Heterotopic ossification was primarily anterior in both groups. Preoperatively in both groups, and including osteophytes in the target regions, HO rates were high at 40.9% and 36.9% for the rhBMP-2/ACS and allograft groups, respectively (p = 0.350). At 24 months, the rate of HO in the rhBMP-2/ACS group was higher than in the allograft group (78.6% vs 59.2%, respectively; p < 0.001). At 24 months, the rate of superior-anterior adjacent-level Park Grade 3 HO was 4.2% in both groups, whereas the rate of Park Grade 2 HO was 19.0% in the rhBMP-2/ACS group compared with 9.8% in the allograft group. At 24 months, the rate of inferior-anterior adjacent-level Park Grade 2/3 HO was 11.9% in the rhBMP-2/ACS group compared with 5.9% in the allograft group. At 24 months, HO rates at the target implant level were similar (p = 0.963). At 24 months, the mean length and anteroposterior diameter of HO were significantly greater in the rhBMP-2/ACS group compared with the allograft group (p = 0.033 and 0.012, respectively). Regarding clinical correlation, at 24 months in both groups, Park Grade 3 HO at superior adjacent-level disc spaces significantly reduced range of motion, more so in the rhBMP-2/ACS group. At 24 months, HO negatively affected Neck Disability Index scores (excluding neck/arm pain scores), neurological status, and overall success in patients in the rhBMP-2/ACS group, but not in patients in the allograft group. CONCLUSIONS Implantation of rhBMP-2/ACS at 1.5 mg/ml with polyetheretherketone spacer and titanium plate is effective in inducing fusion and improving pain and function in patients undergoing ACDF for symptomatic single-level cervical degenerative disc disease. At 24 months, the rate and dimensions (length and anteroposterior diameter) of HO were higher in the rhBMP-2/ACS group. At 24 months, range of motion was reduced, with Park Grade 3 HO in both treatment groups. The impact of Park Grades 2 and 3 HO on Neck Disability Index success, neurological status, and overall success was not consistent among the treatment groups. The study data may offer a deeper understanding of HO after ACDF and may pave the way for improved device designs. Clinical trial registration no.: IDE# G060021; data compared with pooled data from control arms of IDE# G010188/NCT00642876 and IDE# G000123/NCT00437190 ( www.clinicaltrials.gov ).
-
2.
[Clinical application of MC + PEEK cage in traumatic cervical disc herniation].
Jiang, B, Liu, LM, Cao, YQ, Jin, WG, Zhang, XJ, Pan, H
Zhonghua yi xue za zhi. 2012;(41):2909-12
Abstract
OBJECTIVE To explore the clinical outcomes of surgical treatment for traumatic cervical disc herniation with MC + PEEK cage. METHODS A total of 51 patients with traumatic cervical disc herniation in mono-segment were surgically treated. The patients in group A (n = 20) were treated by MC + PEEK cage while those in group B (n = 31) by anterior cervical plate with PEEK cage or titanium mesh. Various parameters of operative duration, blood loss volume, operative complications, bone union, height of intervertebral space and Japanese Orthopedic Association (JOA) score were recorded and compared. RESULTS Fifty-one patients were followed up for an average time of 26 months (range: 6 - 40). Operative duration, blood loss volume and operative complications of group A were better than group B with statistical significance (P < 0.05). Bone union, height of intervertebral space and recovery of spinal cord function were satisfactory with no statistical difference (P > 0.05). CONCLUSION With this new cage, traumatic cervical disc herniation may be safely and micro-invasively treated without the need of anterior cervical plate.
-
3.
Evaluation of autologous platelet concentrate for intertransverse lumbar fusion.
Acebal-Cortina, G, Suárez-Suárez, MA, García-Menéndez, C, Moro-Barrero, L, Iglesias-Colao, R, Torres-Pérez, A
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. 2011;(Suppl 3):361-6
-
-
Free full text
-
Abstract
INTRODUCTION The aim of the study was to analyze if the adding of autologous platelet concentrate (APC) to a mixture of local autograft plus tricalcium phosphate and hidroxiapatite (TCP/HA) would improve the fusion rate in posterolateral lumbar fusion. MATERIALS AND METHODS A prospective, controlled, blinded, non-randomized clinical trial was carried out in 107 patients affected by degenerative lumbar pathology. The study group consisted of 67 patients, in which autologous platelet concentration was added to a mixture of autologous local bone graft and TCP/HA. A control group of 40 patients with same pathology and surgical technique but without APC addition was used to compare the fusion mass obtained. By means of plain X-rays, a blinded evaluation of the intertransverse fusion mass quality at twelve and twenty-four months was made according to type A (bilateral uniform mass), type B (unilateral uniform mass) and type C (irregular or lack bilateral mass). Patients with type C were regarded as pseudoarthrosis. RESULTS In the study group 17 patients had lack or irregular fusion mass (25.4%) versus three patients in the control group (7.5%), which was statistically significant. CONCLUSIONS This study shows that the adding of autologous platelet concentration to a mixture of autologous bone graft plus TCP/HA has decreased our rates of posterolateral lumbar fusion.
-
4.
[Surgical treatment of degenerative lumbar instability by minimally invasive transforaminal lumbar interbody fusion].
Liang, B, Yin, G, Zhao, J, Li, N, Hu, Z
Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery. 2011;(12):1449-54
Abstract
OBJECTIVE To investigate the effectiveness of surgical treatment for single-level degenerative lumbar instability (DLI) by comparing traditional open transforaminal lumbar interbody fusion (TLIF) with minimally invasive TLIF. METHODS Between March 2007 and May 2009, 87 patients with single-level DLI were treated by traditional open TLIF (group A, n = 45) and by minimally invasive TLIF (group B, n = 42), respectively. There was no significant difference in gender, age, disease duration, segment level, combined diseases of lumbar spine, or the proportion of uni- and bilateral symptom between 2 groups (P > 0.05). The indexes of surgical trauma, systemic inflammatory response, clinical outcomes, and paravertebral muscle injury were compared between 2 groups. RESULTS Operation was performed successfully in all patients. The patients were followed up 2.9 years on average in group A and 2.8 years on average in group B. The incision, blood loss, and postoperative drainage in group B were significantly less than those in group A (P < 0.05), but the operation time in group B was significantly longer than that in group A (P < 0.05). There were significant differences (P < 0.05) in C-reactive protein, leucocyte count, and creatine kinase MM between 2 groups at 24 hours postoperatively as well as in C-reactive protein at 6 days postoperatively; group B was superior to group A. At last follow-up, the Oswestry disability index (ODI) and visual analogue score (VAS) were significantly improved when compared with the preoperative scores in 2 groups (P < 0.05). There were significant differences in ODI and back pain VAS score (P < 0.05), but no significant difference in leg pain VAS score (P > 0.05) between 2 groups. At last follow-up, no low back pain occurred in 8 and 18 cases, mild in 25 and 18 cases, moderate in 9 and 6 cases, and severe in 3 and 0 cases in groups A and B, respectively, showing that low back pain was significantly lighter in group B than in group A (Z = 2.574, P = 0.010). At last follow-up, the atrophy ratio of multifidus muscle was 37% +/- 13% in group A and was 15% +/- 7% in group B, showing significant difference (t = 12.674, P = 0.000). The multifidus muscle atrophy was rated as grade I in 18 and 44 sides, as grade II in 42 and 32 sides, and as grade III in 30 and 8 sides in groups A and B, respectively, showing significant difference (Z = -4.947, P = 0.000). CONCLUSION Both traditional open TLIF and minimally invasive TLIF are the effective treatments for single-level DLI. Minimally invasive TLIF has less surgical trauma, slighter postoperative systemic inflammatory response, less paravertebral muscle injury, and lower incidence of postoperative back pain, but it has longer operation time.