Cameron B. Huckell

Pseudarthrosis repair : autogenous iliac crest versus femoral ring allograft

Pseudarthrosis repair in the lumbar spine is one of the most challenging problems faced by spine surgeons. Historically high failure rates with posterior repair have led to the use of anterior lumbar interbody fusion with tricortical iliac crest autograft in these difficult cases. More recently, femoral ring allografts packed with autograft bone have been advocated as another method that would decrease donor site morbidity. Two series of patients underwent anterior lumbar interbody fusion with anterior instrumentation to repair pseudarthrosis (Group I, 33 patients with tricortical autogenous iliac crest and Group II, 20 patients with femoral ring allografts). At minimum 2-year followup, there was no difference in fusion rates (Group I, 32 of 33 versus Group II, 20 of 20). Patients in Group I had radiographic fusion develop more rapidly than patients in Group II (12 months versus 18 months), but a significant proportion of patients in Group I (35%) had an average of 2 mm of graft subsidence. Despite excellent fusion rates in both groups, functional outcomes were not as good with only 28% of patients in Group I and 36% of patients in Group II returning to work. Using anterior instrumentation, anterior interbody fusion offers an excellent method to repair pseudarthrosis using femoral ring allografts or autogenous iliac crest. However, femoral ring allografts offer the potential to decrease donor site morbidity, allowing the surgeon to treat multiple spine levels.

Functional outcome of plate fusions for disorders of the occipitocervical junction.

Twenty-eight patients with average followup of 27 months (range, 12-51 months) required occipitocervical fusion with plates. A 1992 to 1996 consecutive case series enrolled patients prospectively from two institutions. Five surgeons participated. Sixteen patients had inflammatory arthritis; four, osteogenesis imperfecta; three, tumors; three, congenital anomalies; one, pseudarthrosis after odontoid fracture; and one, osteoarthritis. Twenty-two of 28 (78.6%) patients had serious comorbid medical conditions. Additional halo immobilization of 6 weeks was used in 16 of 27 patients. Four patients required revision surgery. No patients showed a decline in neurologic status and average neurologic improvement was one Nurick grade. Two-year followup showed 13 (50%) excellent, nine (34.6%) good, two (7.7%) fair, and two (7.7%) poor outcomes based on a functional outcome scale. There were three deaths during the followup period (overall mortality rate of 10.7%). One death was attributable to airway obstruction, one death 14 months postoperatively was attributable to late Methicillin resistant Staphylococcus aureus sepsis at the bone graft donor site, and one death 41 months postoperatively was attributable to a stroke. The overall fusion rate was 85.2% (23 of 27 patients), with a 96.3% (26 of 27 patients) occipitocervical fusion rate. Three patients had a possible asymptomatic end segment pseudarthrosis with screw loosening. Twenty-two of 26 (84.6%) interviewed patients would choose the surgery again if given the choice.

Clinical outcomes after cervical spine fusion.

The advent of sterile technique, modern anesthesia, and organized industrial society have allowed for great advances and widespread use of cervical arthrodesis for a variety of disorders. This article defines expected outcome for cervical arthrodesis used to treat degenerative disease, trauma, deformity, and a variety of other disorders.

Surgeon perceptions of the complications and value of threaded fusion cages as a spine fusion technique: Results of a consensus survey

BACKGROUND CONTEXT Threaded cage technology has had a meteoric rise in usage. It has been touted as a procedure with low risk and minimal complications. PURPOSE To gauge the spine surgical communitys general consensus regarding cage usage and its complications. STUDY DESIGN/SETTING A canvassing questionnaire regarding threaded cage usage and complications was sent to members of the North American Spine Society. PATIENT SAMPLE A total of 665 doctors reported on their perception of 22,585 cages placed by the second year after pre-market approval from the Food and Drug Administration approval. OUTCOME MEASURES A nonscientific canvassing questionnaire was thought to give a consensus of surgical outcome perception in a large number of caregivers with hopes of understanding general trends. METHODS Simple statistical measurements were used to report perceived complications by surgeons involved in performing threaded cage surgical procedures. RESULTS Sixty-nine percent of doctors reported at least one complication with threaded cages, but the complication incidence was low. Visceral injuries were reported in 0.1%; vascular injuries, 1.0%; cage displacement and dislodgement, 1.4%; temporary and permanent neurologic injuries, 2.25% and 0.56%, respectively; infection 0.34%; retrograde ejaculation 1.2% and revision surgery recorded for 2.7%. Those rating cages as fair to poor (16.5%) were those physicians reporting the longest experience with this technology. CONCLUSIONS The general consensus is that threaded cages have low complication rates and high satisfaction rates, 83.5%. The data represent a convenience sampling and is not scientific.