Prospective Controlled Study of Rectangular Titanium Cage Fusion Compared With Iliac Crest Autograft Fusion in Anterior Cervical Discectomy

Dimitris Zevgaridis, M.D., Claudius Thomé, M.D., Joachim K. Krauss, M.D., Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany.

Neurosurg Focus. 2002;12(1) 

In This Article

Abstract and Introduction

Object. The complications of autogenous bone grafting compel spine surgeons to seek alternative methods for cervical spinal fusion. This prospective study was conducted to evaluate the safety and efficacy of using rectangular titanium cage fusion compared with the widely performed iliac crest autograft fusion.
Methods. A total of 36 patients with cervical disc disease in whom an anterior approach was indicated for discectomy were included in this prospective controlled study. The first 18 consecutive patients received iliac crest autograft; the next 18 consecutive patients received rectangular titanium cages. The intergroup demographic and clinical data were comparable. All patients attended follow up for 1 year. According to Odom criteria, 15 (83%) of 18 patients in both groups experienced good to excellent functional recovery. According to the Patient Satisfaction Index, 17 (94%) of 18 patients in both groups were satisfied. The evaluation of neck pain and arm pain did not indicate statistically significant differences between either group. Fusion was present after 1 year in 16 (89%) of 18 patients who received iliac crest autografts and in 15 (83%) of 18 patients who received rectangular titanium cages. In the autograft group, a pseudarthrosis was present in one patient and marked hip pain was observed in three patients. In the cage group, there was one case of temporary vocal cord paresis but no implant-related complications.
Conclusions. The authors conclude that the use of titanium cages in anterior cervical discectomy constitutes a safe and efficient alternative to iliac crest bone autograft.

Interbody fusion following ACD for treatment of cervical radiculopathy or cervical myelopathy is thought to have several advantages compared with discectomy alone.[37,41]

There is no consensus, however, regarding the optimum substrate for cervical fusion.[46] Iliac crest autografts are most commonly used[12,13,38] and yield fusion rates between 83 and 97%.[7,33] Bone graft harvesting at the iliac crest, however, results in additional patient-related pain and discomfort.[4,32,35] Recently, RTCs have been introduced as a new fusion device applicable in the anterior cervical spine. Clinical experience, thus far, is limited, and at this time these devices have not been approved by the Food and Drug Administration.[2,10,21]

The purpose of this study was to assess the safety and efficacy of RTC fusion compared with standard iliac crest autograft grafting in the treatment of cervical disc disease. First, data were collected prospectively in a control group, which consisted of a consecutive series of 18 patients with cervical disc disease who underwent tricortical iliac crest autograft fusion. In the second arm of the study, the next 18 consecutive patients underwent RTC fusion and were followed prospectively. Evaluation of outcome included radiological and clinical assessments.