PubMed · 7927657
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W Stock, R Hierner. 1994. Vascularized bone transfer.. https://doi.org/10.1016/0020-1383(94)90260-7
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STUDY DESIGN: A retrospective review of all patients surgically treated for adjacent segment disease of the cervical spine over a 20-year period. OBJECTIVES: To determine the clinical and radiographic success of discectomy with interbody grafting and corpectomy with strut grafting in the treatment of adjacent segment disease of the cervical spine. SUMMARY OF BACKGROUND DATA: Up to 25% of all patients undergoing anterior cervical fusion have new disease due to degeneration of an adjacent segment within 10 years. The success of surgical treatment in these patients with adjacent segment disease has not been reported. METHODS: Thirty-eight patients were surgically treated for adjacent segment disease by discectomy with interbody grafting or corpectomy with strut grafting. Arthrodesis was evaluated by flexion-extension lateral radiographs and clinical outcomes were assessed using Robinson's criteria at least 2 years after surgery. Fusion rates were compared by Fisher's exact test, and outcomes were compared by rank-sum analysis. RESULTS: The rate of arthrodesis was significantly lower in the 24 patients treated by discectomy with interbody grafting at one or more levels (63%) than in the 14 patients treated by corpectomy with strut grafting (100%; P = 0.01). Clinical outcomes were similar for the corpectomy and discectomy groups (P = 0.55). There was a trend toward better outcomes in patients who achieved a solid arthrodesis (P = 0.13). CONCLUSIONS: Achieving fusion is more difficult when anterior cervical arthrodesis is performed adjacent to a prior fusion. Strut grafting resulted in a significantly higher rate of arthrodesis than interbody grafting.
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STUDY DESIGN: A morphologic study of the anterior part of the iliac crest was performed. OBJECTIVE: To define the anatomic characteristics of the anterior part of the ilium and to determine an optimal area to harvest the iliac bone graft from the anterior iliac crest. SUMMARY OF BACKGROUND DATA: Stress fracture or avulsion fracture of the anterior cut for anterior iliac crest graft have been noted previously. However, there is insufficient published information on the morphology of the anterior part of the ilium relative to the optimal location of harvesting the bone graft. METHODS: Direct measurements using digital calipers were taken from 30 dried human pelves and 10 cadaveric pelves. The thickness of the anterior part of the ilium was measured, with different starting points on the iliac crest. The length of the bicortical iliac bone graft also was determined. RESULTS: The thickest portion of the ilium was 18.9 +/- 2.3 mm at the iliac tubercle, which was 45% thicker than at a point 3 cm posterior to the anterior superior iliac spine. The thick region of the anterior iliac crest extended 54.0 +/- 10.2 mm posteriorly from a point 3 cm posterior to the anterior superior iliac spine. The mean length of a 10 mm thick bicortical iliac tubercle bone graft was 36.8 +/- 8.7 mm. CONCLUSIONS: The region around the iliac tubercle is suitable for harvesting bicortical or tricortical bone graft.