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Rigid Fusion After Cloward Operation for Cervical Disc Disease Using Autograft, Allograft, or Xenograft: A Randomized Study With Radiostereometric and Clinical Follow-Up Assessment
Dept of Neuro-Orthopedic Surgery, Ryhov Hospital, Jönköping, Sweden.
National Social Insurance Hospital (Research and Rehabilitation Centre), Tranås, Sweden.
Dept of Radiology, Högland Hospital, Eksjö-Nässjö, Sweden.
Dept of Orthopedics, University Hospital, Lund, Sweden.
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2000 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 25, no 15, 1908-1916 p.Article in journal (Refereed) Published
Abstract [en]

Study Design. In this study, 43 patients scheduled for a single-level cervical Cloward procedure for disc disease were randomized prospectively to fusion with autograft, allograft, or xenograft.

Objective. To outline any differences in fusion over time in terms of final mobility and clinical outcome between the three bone grafts.

Summary of Background Data. Fusion is used to relieve pain from a spinal segment. The bovine xenograft gives a fibrous fusion in contrast to the solid bone fusion obtained with autograft from the iliac crest, but no definite differences in clinical outcome have been shown previously after surgery at a single level.

Methods. By use of radiostereometric analysis, 33 patients were observed after 6, 12, and 24 to 50 (mean, 37) months. All 43 patients underwent clinical examination, which involved pain rating before and after surgery, with a final follow-up assessment by an unbiased observer.

Results. Mobility could be demonstrated in 9 patients after 1 year and in 6 patients at the final follow-up assessment, without pain, and with no difference between bone grafts. The patients who received autograft experienced a greater reduction of pain than the patients treated with xenograft.

Conclusions. Most of the patients healed with a rigid fusion no matter which graft was used, but the healing process took longer than expected. The clinical results were not influenced by whether mobility could be demonstrated. There was a tendency toward better clinical results in the patients treated with autograft.

Place, publisher, year, edition, pages
2000. Vol. 25, no 15, 1908-1916 p.
Keyword [en]
bone transplantation, cervical vertebrae, photogrammetry, prospective studies, spinal fusion, transplantation autologous, transplantation heterologous, transplantation homologous
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27851Local ID: 12609OAI: oai:DiVA.org:liu-27851DiVA: diva2:248403
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Outcome and bone grafts in surgical treatment of cervical disc disease: A clinical evaluation using MRI, radiostereometry and measurements of microcirculation and the quality of life
Open this publication in new window or tab >>Outcome and bone grafts in surgical treatment of cervical disc disease: A clinical evaluation using MRI, radiostereometry and measurements of microcirculation and the quality of life
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis was to evaluate the outcome after surgical treatment of cervical disc disease and the influence of different bone grafting methods.

192 patients were studied, of which 149 were treated surgically. They all presented with radiculopathy and/ or myelopathy, and were subjected to an anterior cervical discectomy and fusion as described by Cloward, except for 8 patients operated with a posterior decompression.

43 patients due for surgery were prospectively randomized to fusion with either auto-, allo- or xenograft. 33 of these patients were then monitored by radiostereornetric analysis (RSA) after 6, 12 and 24-50 (mean 37) months, including conventional radiography at the final follow-up. All 43 patients were examined clinically, including pain rating pre- and postoperatively with a final follow-up by an unbiased observer. Mobility could be demonstrated by RSA in 9 patients after one year and at the final follow-up in 6, with no difference between bone grafts. Conventional radiography showed final mobility in only 1 out of these 6 patients. The clinical results were not influenced by whether mobility could be demon strated or not. There was a tendency towards better clinical results in the patients fused with an autograft.

13 patients operated without bone graft had a less favourable clinical outcome compared with 11 patients operated with autograft, retrospectively studied 6- 9 years postoperatively.

The normal postoperative course was followed prospectively in 25 consecutive patients by MRI and clinical reviews, preoperatively and 3 days, 3, 6, 12 and 24 months postoperatively. The results demonstrated that the decompression by an anterior procedure should not be evaluated by MRI until at least 3 months postoperatively. This is because surgical debris behind the bone dowel is impossible to distinguish from remaining osteophytes or disc fragments. MRI-findings of foraminal narrowing were common postoperatively among patients with no remaining radiculopathy. A rim sign was permanent with high signal enhancement around the bovine xenograft after i. v. contrast, indicating fibrous healing.

Surgically treated patients experienced a pain reduction as measured by visual analogue pain scales (VAS) and showed an improvement in clinical findings, when followed by unbiased observers at least 2 years after surgery. Some recurrence of pain and other symptoms was common 3 to 6 months postoperatively. The improvement in quality of life measured by Sickness Impact Profile (SIP) in 43 operated patients was mainly temporary, even if a sustained improvement after 2 years was observed among the operated patients that were referred directly to us.

No corresponding changes in pain, clinical findings or SIP were seen among 41 conservatively treated patients, matched for gender and age.

Measurements of microcirculation and electromyography in the trapezius muscles during increased static load before and 9 months after surgery (27 patients) showed a tendency towards increased microcirculation and increased muscle activation. There was a more evident response on the less painful side, as well as among the 8 patients operated using a posterior approach.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 58 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 621
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28059 (URN)12823 (Local ID)91-7219-578-9 (ISBN)12823 (Archive number)12823 (OAI)
Public defence
2000-03-31, Berzeliussalen, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-25Bibliographically approved

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Löfgren, HåkanRyd, LeifLevander, Bo

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