Original ArticleImproved Bone Graft Method for Upper Cervical Surgery with Posterior Approach: Technical Description and Report of 52 Cases
Introduction
Instability of the upper cervical spine is a complicated and life-threatening problem in the field of spinal surgery. For this problem, numerous surgical techniques have being used to achieve nerve decompression, anatomic structural stability, and arthrodesis. Because of the high mobility of the upper cervical spine, reliable internal fixation methods are needed to get immediate or permanent stabilization and improve the fusion rate. Meanwhile, an appropriate and effective bone graft method is the premise of a successful bone fusion. Though most published studies have shown high fusion rates in these kinds of surgery techniques,1 the related pseudarthrosis problems still exist and much more than the observed ones.2, 3, 4 Therefore the new and predominant bone graft method still needs to be researched. Here we describe an improved graft method and provide a retrospective analysis of relevant cases.
Section snippets
Methods
This study was approved by the institutional review board of the hospital. Retrospective analysis of Chinese patients from January 2011 to January 2013 involved 52 consecutive patients, who had odontoid nonunion (33 cases), atlantoaxial instability (11 cases), and occipitocervical deformity (8 cases) who underwent posterior C1-C2 transarticular screw/screw-rod internal fixation (41 cases) and occipitocervical fusion (11 cases) with the new bone graft technique. Each surgical procedure was
Results
In this series, all cases showed satisfactory screw fixation by radiographic examination and there were no postoperative neurologic complications. There was 1 case with postoperative retropharyngeal infection after transoral release and posterior reduction by pedicle screw instrumentation. All patients got solid fusions, and no pseudarthrosis occurred. All cases presented with solid fusion at the 3-month follow-up. The average follow-up period was 21 months (range, 5–38 months). Figure 3 shows
Discussion
Spinal arthrodesis is an important method for solving the instability problem that occurs in the cervical spine. With the evolving surgical techniques, from noninstrumented techniques to modern polyaxial screw and rod technology, the bone graft methods used in these surgeries have evolved, too. Today, though numerous bone graft methods have been proven effective in getting a high fusion rate in many studies, the nonunion of bone graft in some methods still exists.2, 3, 4 The new bone graft
Conclusion
In conclusion, good bone graft bed, enough bone graft material, solid local fixation, and effective bone graft method are prerequisites for a successful bone graft. By analyzing postoperative follow-up in the consecutive cases of this study, our improved bone graft method describing an improved bone graft structure is a reliable posterior fusion technique. It is worth consideration, and the further research is needed.
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Cited by (3)
Comparison of Two Bone Grafting Techniques Applied During Posterior C1-C2 Screw-Rod Fixation and Fusion for Treating Reducible Atlantoaxial Dislocation
2020, World NeurosurgeryCitation Excerpt :However, reliable fixation alone without solid fusion cannot result in long-lasting C1-C2 stability. Thus, a rigid fixation construct, a sufficient bone graft bed, and high-quality bone graft material with the use of a superior bone grafting technique are prerequisites for firm bone fusion and long-term clinical outcomes.16 In our study, a 100% fusion rate was obtained without application of an adjunct bone growth stimulator in both groups, with only 1 patient in the SBG group experiencing delayed fusion.
The efficiency of internal fixation with bone grafting at docking sites after bone transport for treatment of large segmental tibial bone defects
2021, American Journal of Translational Research
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.