|
(Continued from page 41)
are allowed to ambulate after four hours and discharged if they desire. Outpatients were discharged within 23 hours. Outpatients reported complete resolution of their preoperative radicular pain. The patients are seen in the office at two weeks, with a pre-office lateral cervical spine x-ray centered at the site of the graft. They have a repeat office visit with lateral cervical spine x-ray at six weeks, and every six weeks thereafter until their graft is fused. For the first two weeks, they are instructed to wear their Philadelphia cervical collar at all times. Thereafter they wear it for 23 hours of the day until they are fused. Patients are told that their wounds are not completely healed for three months and that they should restrain from any neck strenuous activity until that time.
RESULTS
The patients are instructed to wear their Philadelphia cervical collars until a minimum of 60% of the horizontal surface of both the superior and inferior aspects of the graft have fused. This is determined by the neurosurgeon and based on the lack of a lucent line versus a sclerotic line at the graft vertebrae interface.
18 patients had the addition of coral chips to their fibular strut grafts, whereas 30 patients did not. 60% or greater of both the superior and inferior surfaces were fused at two weeks in 15 of the 18 patients with coral chips, and only 10 of the 30 patients without coral chips. At six weeks 18 of the 18 patients were fused, whereas only 24 of 30 patients were fused without chips. At 12 weeks 29 of the 30 patients without coral chips were fused. Those patients that had fusion at two weeks were re-x-rayed at six weeks in order to determine that there was no change after the cervical collar was removed. The one patient had pseudoarthrosis without micro-instability and without clinical symptoms. There was no evidence of graft collapse in the early post operative period.
DISCUSSION
Most published studies do not report a significant difference of fusion utilizing allograft versus autograft bone. Most persistent clinical symptoms are due to pseudoarthrosis and, therefore, we should strive for 100% fusion. Allograft bone has many advantages over autograft, with the exception of the possibility for disease transmission. This study demonstrates that augmentation of allograft fusion can lead to 100% interbody arthrodesis without graft collapse in as little as two weeks. It would be beneficial to study the long term effects for graft collapse and the possible use of coral block alone if a
(Continued on page 43)
|
