Biocompatible osteoconductive polymer versus iliac graft. A prospective comparative study for the evaluation of fusion pattern after anterior cervical discectomy.
METHODS
One hundred fifteen patients having symptomatic cervical disc disease were recruited prospectively for this study. They were allocated randomly for either autologous iliac bone graft or biocompatible osteoconductive polymer implants. Both groups were compared clinically and radiologically.


OBJECTIVE
Complications, long-term clinical and radiologic outcome, and hospital stay were compared to determine if biocompatible osteoconductive polymer was an improvement on iliac bone graft in terms of reduced donor site pain and shortened hospital stay.


BACKGROUND
Donor site morbidity is a significant problem in anterior cervical fusion. Hospital stay is another factor in the recent era of cost consciousness. Biocompatible osteoconductive polymer has been used in many centers as a biodegradable implant to circumvent these problems.


METHODS
Smith-Robinson technique was used in 74 patients, and Cloward technique was used in 41 patients. Sixty-five patients had biocompatible osteoconductive polymer implants, and 50 patients had iliac bone graft. Patients were followed-up routinely in the outpatient clinic where pain visual analogue scale and Odom's criteria were used for outcome evaluation. Plain radiography, computed tomography scan, and magnetic resonance imaging were used for radiologic evaluation.


RESULTS
The mean hospital stay was 4.8 days for those with iliac bone graft and 4.7 days for those with biocompatible osteoconductive polymer. Clinical outcome was identical in both groups. The incidence of partial graft protrusion and postoperative intersegmental kyphosis was statistically higher with iliac bone graft (P = 0.018 and P = 0.02, respectively). "Sclerosis" started to form around biocompatible osteoconductive polymer like a "halo" at 2 months. It increased with time, and sometimes was associated with new osteophyte formation; however, there was no biocompatible osteoconductive polymer incorporation or biodegradation


CONCLUSIONS
Biocompatible osteoconductive polymer acts as a good "spacer" that reduces graft collapse and intersegmental kyphosis. However, it did not show any radiologic evidence of biodegradation or incorporation during the follow-up period of 24 months.
Department of Surgical Neurology, National Hospital for Neurology and Neurosurgery, London, England.
A A
AA
Madawi
M
M
Powell
H A
HA
Crockard
D000328:Adult; D001672:Biocompatible Materials / Q000191:economics / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D002574:Cervical Vertebrae / Q000601:surgery; D017586:Diskectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation; D007738:Kyphosis / Q000000981:diagnostic imaging; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D016348:Osseointegration / Q000502:physiology*; D011108:Polymers; D011183:Postoperative Complications; D011859:Radiography; D016896:Treatment Outcome
D001672:Biocompatible Materials; D011108:Polymers