Tag Archive for: Tricortical bone graft

Volume 2 | Issue 2 | October 2021-March 2022 | page: 79-83 | Md. Anowarul Islam, Md. Shohidullah, Rumana Islam, Afia Ibnat Islam, Abu Zaffar Chowdhury

DOI: 10.13107/bbj.2022.v02i02.025

Authors: Md. Anowarul Islam [1], Md. Shohidullah [1], Rumana Islam [1], Afia Ibnat Islam [1], Abu Zaffar Chowdhury [1]

[1] Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Address of Correspondence
Dr. Anowarul Islam,
Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
E-mail: maislam.spine@gmail.com

Abstract

Background: Cervical spondylotic myeloradiculopathy is a common cause of neck pain and radiating arm pain. It develops when one or more of the intervening discs in the cervical spine starts to break down by wear and tear due to its degeneration. Multiple fixation modalities are used in Anterior Cervical Discectomy and interbody Fusion (ACDF), with their positive and negative sides
Objectives: The objective of the study is to compare the safety and efficacy of ACDF by standalone Polyetheretherketone (PEEK) cages with tricortical bone graft with anterior plate fixation for cervical spondylotic myeloradiculopathy.
Methods: This prospective observational study was conducted in the Department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2017 to June 2020. Forty patients with cervical spondylotic myeloradiculopathy diagnosed on the basis of presenting complaints, clinical examination, and investigations were enrolled in this study. Modified Odom’s criteria, visual analog scale (VAS), Nurick Grading, and Bridwell criteria for cervical spondylotic myelopathy was used for evaluation of the results.
Result: Male were predominant in this study. Male-female ratio was 2.9: 1. Most of the patients were farmer (30%), C5/6 (55%) was the most commonly involved disc level. Most of the patients had clinical features of neck pain, gait difficulty, and myelopathy sign. Regarding perioperative complications transient dysphagia was seen in 5 (12.5%) patients and transient paraparesis was observed in 2 (5%) patients. Post-operative complications were paresthesia and wound infection seen in significant number of patients of both groups who were recovered within 3–6 months. According to Bridwell’s grade of fusion, Grade I fusion was observed in 16 patients (80%) in cage group and 18 patients (90%) in tricortical Indocyanine Green (ICG) with plate group. According to VAS, postoperatively pain was gradually decline and after 12 months, 12 patients (60%) patients were found in no pain group and 11 patients (55%) were found in no pain group of the tricortical ICG with plate group. There was no significant difference between the two groups (P = 0.04). According to modified Odom’s criteria functional outcome after 12 months was excellent in 18 patients (90%) and good in 2 patients (10%) in cage group and excellent in 17 patients (85%) and good in 3 patients (15%) in tricortical ICG with plate group. There was no statistically significant difference between two groups (P = 0.432).
Conclusion: ACDF is the ideal technique for the treatment of cervical spondylotic myeloradiculopathy with excellent functional outcome and good fusion which could be achieved by either standalone PEEK cage or tricortical ICG with plate and there is no significant difference between two techniques.
Keywords: Cervical spondylotic myeloradiculopathy, Tricortical bone graft, Anterior cervical discectomy and fusion.

References

1. Rao RD, Currier BL, Albert TG. Degenerative cervical Spondylosis clinical syndromes, pathogenesis, and management. J Bone Joint Surg 2007;89:1360-78.
2. Waltz TA. Physical factors in the production of the myelopathy of cervical spondylosis. Brain 1967;90:395-404.
3. Robinson RA, Afeiche N, Dunn EJ, Northrup BE. Cervical spondylotic myelopathy, etiology and treatment concepts. Spine 1977;2:89-99.
4. Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg 1993;75:1298-307.
5. Wilkinson M. The morbid anatomy of cervical spondylosis and myelopathy. Brain 1960;83:589-616.
6. Spallone A, Marchione P. Anterior cervical discectomy and fusion with “mini-invasive” harvesting of iliac crest graft versus polyetheretherketone (PEEK) cages: A retrospective outcome analysis. Int J Surg 2014;12:1328-32.
7. Islam MA, Rana MM, Goni MF, Rahman MN. Comparison between anterior cervical discectomy with fusion by polyetheretherketone cages and tricortical iliac crest graft for the treatment of cervical prolapsed intervertebral disc. Bangabandhu Sheikh Mujib Med Univ J 2016;9:169-72.
8. Sharma A, Kishore H. Comparative study of functional outcome of anterior cervical decompression and interbody fusion with tricortical stnad alone iliac crest autograft versus stand-alone polyetheretherketone cage in cervical spondylotic myelopathy. Glob Spine J 2018;8:860-5.
9. Siddiqui AA, Jackowski A. Cage versus tricortical graft for cervical interbody fusion. J Bone Joint Surg Br 2003;85:1019-25.
10. Lee JC, Jang HD, Ahn J, Choi SW, Kang D, Shin BJ. Comparison of cortical ring allograft and plate fixation with autologous iliac bone graft for anterior cervical discectomy and fusion. Asian Spine J 2019;13:258-64.
11. Adam FF, Hasan KM, Meshtaway EM, Refae EH. PEEK cages versus locked plate for multiple levels cervical degenerated disease. J Am Sci 2013;9:100-6.
12. Islam MA, Habib MA, Sakeb N. Anterior cervical discectomy, fusion and stabilization by plate and screw early experience. Bangladesh Med Res Council Bull 2012;38:62-6.
13. Abdallah A, Taha AM. Cages or plates for anterior interbody fusion for cervical radiculopathy: Single and double levels. Egypt Orthop J 2016;51:65-70.
14. Ayman EA, Galhom MD. Comparison between polyetheretherketone cages versus an iliac crest autograft used in treatment of single or double level anterior cervical discectomy. Med J Cairo Univ 2013;81:9-17.
15. Shao MH, Zhang F, Xu HC, Lyu FZ. Titanium cages versus autogenous iliac crest bone grafts in anterior cervical discectomy and fusion treatment of patients with cervical degenerative diseases: A systematic review and meta-analysis. Curr Med Res Opin 2017;33:803-11.
16. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958;40:607-24.

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