Current Concepts Review - Interbody Fusion Cages in Reconstructive Operations on the Spine* by PAUL C. MCAFEE J Bone Joint Surg Am Volume 81(6):859-80.

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Presentation transcript:

Current Concepts Review - Interbody Fusion Cages in Reconstructive Operations on the Spine* by PAUL C. MCAFEE J Bone Joint Surg Am Volume 81(6): June 1, 1999 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-A Photograph showing some of the devices studied by Kanayama et al.47, who used silicone elastomer gel inside cages to measure intracage pressures under in vitro loading conditions in an investigation of the forces acting on bone graft within differe... PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-B Bar graph showing the intracage pressure measurements for the ten cage constructs. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-A Microradiographs showing the extent of trabecular remodeling fourteen years after treatment with a Bagby basket (Fig. 2-A) and a bone-dowel allograft (Fig. 2-B, arrows) from the study by Cunningham et al.27, who examined six equine specimens at an... PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-B Microradiographs showing the extent of trabecular remodeling fourteen years after treatment with a Bagby basket (Fig. 2-A) and a bone-dowel allograft (Fig. 2-B, arrows) from the study by Cunningham et al.27, who examined six equine specimens at an... PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-A Radiographs demonstrating the paradox regarding a solid fusion compared with a so- called functional arthrodesis. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-B Radiographs demonstrating the paradox regarding a solid fusion compared with a so- called functional arthrodesis. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 4-A, 4-B, and 4-C: It is often difficult to confirm a lumbar fusion with use of flexion and extension radiographs alone. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-B Illustration (Fig. 4-B) showing the principle of ream long-cage short66, which ensures that additional cancellous bone (Fig. 4-C, arrows) can be visualized anterior to the cage. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-C Illustration (Fig. 4-B) showing the principle of ream long-cage short66, which ensures that additional cancellous bone (Fig. 4-C, arrows) can be visualized anterior to the cage. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 5-A through 5-G: Magnetic resonance images and radiographs of a thirty-five-year-old man who was managed with a biological (hybrid) threaded femoral bone-dowel allograft packed with autogenous iliac-crest bone graft. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-B: Magnetic resonance image made within one month after the operation, showing pyogenic vertebral osteomyelitis. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-C Radiograph made after six weeks of intravenous administration of antibiotics. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-D Anteroposterior and lateral radiographs made three months after treatment with a threaded femoral cortical bone-dowel allograft, demonstrating restoration of interbody and posterior neuroforaminal height. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-E Anteroposterior and lateral radiographs made three months after treatment with a threaded femoral cortical bone-dowel allograft, demonstrating restoration of interbody and posterior neuroforaminal height. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-F Anteroposterior and lateral radiographs made two years postoperatively, demonstrating the extent of remodeling possible with use of a threaded femoral bone-dowel allograft. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-G Anteroposterior and lateral radiographs made two years postoperatively, demonstrating the extent of remodeling possible with use of a threaded femoral bone-dowel allograft. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-A Anteroposterior and lateral radiographs showing the extent of the fusion (arrows, Fig. 6- A) two years after an arthrodesis through a minimally invasive retroperitoneal approach that allowed two larger fusion cages to be inserted in a lateral direct... PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-B Anteroposterior and lateral radiographs showing the extent of the fusion (arrows, Fig. 6- A) two years after an arthrodesis through a minimally invasive retroperitoneal approach that allowed two larger fusion cages to be inserted in a lateral direct... PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Figs. 7-A, 7-B, and 7-C: Histological and microradiographic appearance of a solid fusion obtained with a lateral BAK cage filled with recombinant osteogenic protein-1 in the study by Cunningham et al.29. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-B At a higher magnification, the section demonstrates the trabecular architecture within the BAK device (x 10). PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-C Midsagittal microradiograph, the so-called gold standard for documenting fusion. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 8 Bar graph showing lateral bending stiffnesses of spinal segments from sheep four months after operative treatment. PAUL C. MCAFEE J Bone Joint Surg Am 1999;81: ©1999 by The Journal of Bone and Joint Surgery, Inc.