1.Could the Type of Allograft Used for Anterior Cervical Discectomy and Fusion Affect Surgical Outcome? A Comparison Between Cortical Ring Allograft and Cortico-Cancellous Allograft
Gumin JEONG ; Hyun Wook GWAK ; Sehan PARK ; Chang Ju HWANG ; Jae Hwan CHO ; Dong-Ho LEE
Clinics in Orthopedic Surgery 2025;17(2):238-249
Background:
Allograft is predominantly used interbody spacers for anterior cervical discectomy and fusion (ACDF). The corticocancellous allograft has weaker mechanical strength as it is an artificial composite of the cancellous and cortical parts. Additionally, whether utilizing a firmer allograft, such as the cortical ring, leads to better outcomes is unclear. Therefore, we aimed to compare the surgical outcomes of cortical ring and cortico-cancellous allografts in ACDF.
Methods:
Patients who underwent ACDF using allograft and were followed up for > 1 year were retrospectively reviewed. Patient characteristics, including fusion rates (assessed by interspinous motion [ISM], intra-graft bone bridging, and extra-graft bone bridging), subsidence, allograft complications (e.g., allograft fracture and resorption), and patient-reported outcome measures (neck pain visual analog scale [VAS], arm pain VAS, and neck disability index), were assessed. Patients were divided into 2 groups based on the allograft used: cortical ring and cortico-cancellous allograft groups. Subgroup analysis was subsequently conducted in singleand multi-level operation groups.
Results:
A total of 227 patients were included. Of them, 134 (59.0%) and 93 (41.0%) underwent ACDF using cortical ring and corticocancellous allograft, respectively. In single-level operations, the cortico-cancellous allograft significantly frequented allograft resorption (24 / 66, 36.4%) than the cortical ring allograft (1 / 28, 3.7%) (p = 0.001). The cortico-cancellous allograft group demonstrated significantly greater subsidence. However, the fusion rates did not significantly differ between the 2 groups. In multi-level operations, the cortico-cancellous allograft (5 / 27, 18.5%) resulted in a significantly higher fracture rate than the cortical ring allograft (5 / 105, 4.7%) (p = 0.030). The fusion rate at 1-year postoperative assessed using ISM (63.2% vs. 55.5%) and intra-graft bone bridging (66.7% vs. 40.7%) was higher in the cortical ring group; however, the difference was not significant. The patient-reported outcomes at 1-year postoperative did not demonstrate significant intergroup differences both in single- and multi-level operations.
Conclusions
Allograft resorption or fracture occurs more frequently with cortico-cancellous than cortical ring allografts. Despite the frequent occurrence of allograft-related complications with cortico-cancellous allografts, the fusion rate was not significantly affected. Due to the higher rate of allograft resorption or fractures and greater subsidence with cortico-cancellous allografts, cortical ring allografts might yield more stable results in ACDF.
2.Could the Type of Allograft Used for Anterior Cervical Discectomy and Fusion Affect Surgical Outcome? A Comparison Between Cortical Ring Allograft and Cortico-Cancellous Allograft
Gumin JEONG ; Hyun Wook GWAK ; Sehan PARK ; Chang Ju HWANG ; Jae Hwan CHO ; Dong-Ho LEE
Clinics in Orthopedic Surgery 2025;17(2):238-249
Background:
Allograft is predominantly used interbody spacers for anterior cervical discectomy and fusion (ACDF). The corticocancellous allograft has weaker mechanical strength as it is an artificial composite of the cancellous and cortical parts. Additionally, whether utilizing a firmer allograft, such as the cortical ring, leads to better outcomes is unclear. Therefore, we aimed to compare the surgical outcomes of cortical ring and cortico-cancellous allografts in ACDF.
Methods:
Patients who underwent ACDF using allograft and were followed up for > 1 year were retrospectively reviewed. Patient characteristics, including fusion rates (assessed by interspinous motion [ISM], intra-graft bone bridging, and extra-graft bone bridging), subsidence, allograft complications (e.g., allograft fracture and resorption), and patient-reported outcome measures (neck pain visual analog scale [VAS], arm pain VAS, and neck disability index), were assessed. Patients were divided into 2 groups based on the allograft used: cortical ring and cortico-cancellous allograft groups. Subgroup analysis was subsequently conducted in singleand multi-level operation groups.
Results:
A total of 227 patients were included. Of them, 134 (59.0%) and 93 (41.0%) underwent ACDF using cortical ring and corticocancellous allograft, respectively. In single-level operations, the cortico-cancellous allograft significantly frequented allograft resorption (24 / 66, 36.4%) than the cortical ring allograft (1 / 28, 3.7%) (p = 0.001). The cortico-cancellous allograft group demonstrated significantly greater subsidence. However, the fusion rates did not significantly differ between the 2 groups. In multi-level operations, the cortico-cancellous allograft (5 / 27, 18.5%) resulted in a significantly higher fracture rate than the cortical ring allograft (5 / 105, 4.7%) (p = 0.030). The fusion rate at 1-year postoperative assessed using ISM (63.2% vs. 55.5%) and intra-graft bone bridging (66.7% vs. 40.7%) was higher in the cortical ring group; however, the difference was not significant. The patient-reported outcomes at 1-year postoperative did not demonstrate significant intergroup differences both in single- and multi-level operations.
Conclusions
Allograft resorption or fracture occurs more frequently with cortico-cancellous than cortical ring allografts. Despite the frequent occurrence of allograft-related complications with cortico-cancellous allografts, the fusion rate was not significantly affected. Due to the higher rate of allograft resorption or fractures and greater subsidence with cortico-cancellous allografts, cortical ring allografts might yield more stable results in ACDF.
3.Could the Type of Allograft Used for Anterior Cervical Discectomy and Fusion Affect Surgical Outcome? A Comparison Between Cortical Ring Allograft and Cortico-Cancellous Allograft
Gumin JEONG ; Hyun Wook GWAK ; Sehan PARK ; Chang Ju HWANG ; Jae Hwan CHO ; Dong-Ho LEE
Clinics in Orthopedic Surgery 2025;17(2):238-249
Background:
Allograft is predominantly used interbody spacers for anterior cervical discectomy and fusion (ACDF). The corticocancellous allograft has weaker mechanical strength as it is an artificial composite of the cancellous and cortical parts. Additionally, whether utilizing a firmer allograft, such as the cortical ring, leads to better outcomes is unclear. Therefore, we aimed to compare the surgical outcomes of cortical ring and cortico-cancellous allografts in ACDF.
Methods:
Patients who underwent ACDF using allograft and were followed up for > 1 year were retrospectively reviewed. Patient characteristics, including fusion rates (assessed by interspinous motion [ISM], intra-graft bone bridging, and extra-graft bone bridging), subsidence, allograft complications (e.g., allograft fracture and resorption), and patient-reported outcome measures (neck pain visual analog scale [VAS], arm pain VAS, and neck disability index), were assessed. Patients were divided into 2 groups based on the allograft used: cortical ring and cortico-cancellous allograft groups. Subgroup analysis was subsequently conducted in singleand multi-level operation groups.
Results:
A total of 227 patients were included. Of them, 134 (59.0%) and 93 (41.0%) underwent ACDF using cortical ring and corticocancellous allograft, respectively. In single-level operations, the cortico-cancellous allograft significantly frequented allograft resorption (24 / 66, 36.4%) than the cortical ring allograft (1 / 28, 3.7%) (p = 0.001). The cortico-cancellous allograft group demonstrated significantly greater subsidence. However, the fusion rates did not significantly differ between the 2 groups. In multi-level operations, the cortico-cancellous allograft (5 / 27, 18.5%) resulted in a significantly higher fracture rate than the cortical ring allograft (5 / 105, 4.7%) (p = 0.030). The fusion rate at 1-year postoperative assessed using ISM (63.2% vs. 55.5%) and intra-graft bone bridging (66.7% vs. 40.7%) was higher in the cortical ring group; however, the difference was not significant. The patient-reported outcomes at 1-year postoperative did not demonstrate significant intergroup differences both in single- and multi-level operations.
Conclusions
Allograft resorption or fracture occurs more frequently with cortico-cancellous than cortical ring allografts. Despite the frequent occurrence of allograft-related complications with cortico-cancellous allografts, the fusion rate was not significantly affected. Due to the higher rate of allograft resorption or fractures and greater subsidence with cortico-cancellous allografts, cortical ring allografts might yield more stable results in ACDF.
4.Could the Type of Allograft Used for Anterior Cervical Discectomy and Fusion Affect Surgical Outcome? A Comparison Between Cortical Ring Allograft and Cortico-Cancellous Allograft
Gumin JEONG ; Hyun Wook GWAK ; Sehan PARK ; Chang Ju HWANG ; Jae Hwan CHO ; Dong-Ho LEE
Clinics in Orthopedic Surgery 2025;17(2):238-249
Background:
Allograft is predominantly used interbody spacers for anterior cervical discectomy and fusion (ACDF). The corticocancellous allograft has weaker mechanical strength as it is an artificial composite of the cancellous and cortical parts. Additionally, whether utilizing a firmer allograft, such as the cortical ring, leads to better outcomes is unclear. Therefore, we aimed to compare the surgical outcomes of cortical ring and cortico-cancellous allografts in ACDF.
Methods:
Patients who underwent ACDF using allograft and were followed up for > 1 year were retrospectively reviewed. Patient characteristics, including fusion rates (assessed by interspinous motion [ISM], intra-graft bone bridging, and extra-graft bone bridging), subsidence, allograft complications (e.g., allograft fracture and resorption), and patient-reported outcome measures (neck pain visual analog scale [VAS], arm pain VAS, and neck disability index), were assessed. Patients were divided into 2 groups based on the allograft used: cortical ring and cortico-cancellous allograft groups. Subgroup analysis was subsequently conducted in singleand multi-level operation groups.
Results:
A total of 227 patients were included. Of them, 134 (59.0%) and 93 (41.0%) underwent ACDF using cortical ring and corticocancellous allograft, respectively. In single-level operations, the cortico-cancellous allograft significantly frequented allograft resorption (24 / 66, 36.4%) than the cortical ring allograft (1 / 28, 3.7%) (p = 0.001). The cortico-cancellous allograft group demonstrated significantly greater subsidence. However, the fusion rates did not significantly differ between the 2 groups. In multi-level operations, the cortico-cancellous allograft (5 / 27, 18.5%) resulted in a significantly higher fracture rate than the cortical ring allograft (5 / 105, 4.7%) (p = 0.030). The fusion rate at 1-year postoperative assessed using ISM (63.2% vs. 55.5%) and intra-graft bone bridging (66.7% vs. 40.7%) was higher in the cortical ring group; however, the difference was not significant. The patient-reported outcomes at 1-year postoperative did not demonstrate significant intergroup differences both in single- and multi-level operations.
Conclusions
Allograft resorption or fracture occurs more frequently with cortico-cancellous than cortical ring allografts. Despite the frequent occurrence of allograft-related complications with cortico-cancellous allografts, the fusion rate was not significantly affected. Due to the higher rate of allograft resorption or fractures and greater subsidence with cortico-cancellous allografts, cortical ring allografts might yield more stable results in ACDF.
5.Helicobacter pylori Eradication Rate in Patients with Diabetes.
Jiyeon YOO ; Yeong Ji YU ; Gumin CHO ; Hongkwon OH ; Seung Hyun OH ; Tae Ho KIM ; Jung Hwan OH
The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2017;17(2):83-87
BACKGROUND/AIMS: The prevalence of diabetes mellitus is increasing. Little is known about the difference in Helicobacter pylori eradication rates between diabetic patients and non-diabetics. The aim of this study was to compare the eradication rate between diabetic and non-diabetic patients. MATERIALS AND METHODS: The medical records of patients who received a proton pump inhibitor (PPI)-based eradication therapy between 2012 and 2015 were retrospectively reviewed. All the patients underwent endoscopic biopsy to confirm H. pylori infection. Successful eradication was confirmed by using the ¹³C-urea breath test, biopsy, or rapid urease test, which was performed at least 4 weeks after the end of eradication therapy. RESULTS: A total of 1,402 patients were included. The eradication rate was 74.3% (1,041/1,402; 95% CI, 72.0~76.5%). Excluding 151 patients who were confirmed to have no diabetes, 182 diabetic and 1,069 non-diabetic patients were compared. No significant difference (P=0.667) in eradication rate with PPI-amoxicillin-clarithromycin therapy was found between the diabetic (75.8%, 138/182; 95% CI, 69.6~82.0%) and non-diabetic groups (74.0%, 791/1,069; 95% CI, 71.4~76.6%). Peptic ulcer was much more common in the diabetic group than in the non-diabetic group (67.0% vs. 57.9%, P=0.038). CONCLUSIONS: The H. pylori eradication rate with PPI-based triple therapy in the diabetic patients was probably not different from that in non-diabetic patients.
Biopsy
;
Breath Tests
;
Diabetes Mellitus
;
Helicobacter pylori*
;
Helicobacter*
;
Humans
;
Medical Records
;
Peptic Ulcer
;
Prevalence
;
Proton Pumps
;
Retrospective Studies
;
Urease