Recently, a bioactive glass ceramic (BGC) has been developed for use as intervertebral cages for anterior cervical discectomy and fusion (ACDF). However, the effectiveness and safety of BGC cages remain to be evaluated. We completed a retrospective comparison of the radiological and clinical outcomes of 36 patients (52 levels) who underwent ACDF with a BGC cage and 35 patients (54 levels) using allograft bone. The following variables were compared between the two groups: the visual analog (VAS) neck and arm pain score and the neck disability index (NDI), measured before surgery and 1 year after; the change in Cobb’s angle, between the C2 and C7 vertebrae, the global sagittal angle, and disc height compared from before surgery to 1 year after; and the rate of spinal fusion and cage subsidence at 1 and 2 years after surgery. The VAS and NDI scores were not different between the two groups. Similarly, the spinal fusion rate was not different between the BGC and allograft bone group at 1 year (73% and 87%, respectively; p = 0.07) and 2 years (94% and 91%, respectively; p = 0.54) after surgery. However, the rate of cage subsidence was higher in the allograft bone (43%) than the BGC (19%) group (p = 0.03), as was the rate of instrument-related failure (p = 0.028), with a specifically higher incidence of implant fracture or failure in the allograft bone group (p = 0.025). Overall, our findings indicate that BGC cages provide a feasible and safe alternative to allograft bone for ACDF.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Arvind V, Kim JS, Oermann EK, Kaji D, Cho SK (2018) Predicting surgical complications in adult patients undergoing anterior cervical discectomy and fusion using machine learning. Neurospine 15:329–337
Ba Z, Zhao W, Wu D, Shen B, Yu B, Wang Z (2012) Box cages packed with local decompression bone were efficient in anterior cervical discectomy and fusion: five- to 10-year follow-up. Spine (Phila Pa 1976) 37:E1260–E1263
Bartels RH, Donk RD, Feuth T (2006) Subsidence of stand-alone cervical carbon fiber cages. Neurosurgery 58:502–508 discussion 502-508
Börm W, Seitz K (2004) Use of cervical stand-alone cages. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 13:474–475 author reply 476
Chen Y, Lu G, Wang B, Li L, Kuang L (2016) A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up. Eur Spine J 25:2255–2262
Chong E, Pelletier MH, Mobbs RJ, Walsh WR (2015) The design evolution of interbody cages in anterior cervical discectomy and fusion: a systematic review. BMC Musculoskelet Disord 16:99
Deora H, Kim S-H, Behari S, Rudrappa S, Rajshekhar V, Zileli M, Parthiban JKBC (2019) Anterior surgical techniques for cervical spondylotic myelopathy: WFNS spine committee recommendations. Neurospine 16:408–420
Diebo BG, Oren JH, Challier V, Lafage R, Ferrero E, Liu S, Vira S, Spiegel MA, Harris BY, Liabaud B, Henry JK, Errico TJ, Schwab FJ, Lafage V (2016) Global sagittal axis: a step toward full-body assessment of sagittal plane deformity in the human body. J Neurosurg Spine 25:494–499
Fountas KN, Kapsalaki EZ, Machinis T, Robinson JS (2006) Extrusion of a screw into the gastrointestinal tract after anterior cervical spine plating. J Spinal Disord Tech 19:199–203
Fujibayashi S, Shikata J, Kamiya N, Tanaka C (2000) Missing anterior cervical plate and screws: a case report. Spine (Phila Pa 1976) 25:2258–2261
Ghanayem AJ, Zdeblick TA (1996) Cervical spine infections. Orthop Clin North Am 27:53–67
Mansfield HE, Jeffrey Canar W, Gerard CS, O'Toole JE (2014) Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis. Neurosurg Focus 37:E9
Haws BE, Khechen B, Patel DV, Yoo JS, Guntin JA, Cardinal KL, Singh K (2019) Swallowing function following anterior cervical discectomy and fusion with and without anterior plating: a SWAL-QOL (Swallowing-Quality of Life) and Radiographic Assessment. Neurospine 16:601–607
Heidt ST, Louie PK-H, Khan JM, Basques BA, Hirsch B, Varthi A, Paul JC, Goldberg EJ, An HS (2019) Comparing allografts to autografts for maintenance of cervical sagittal parameters and clinical outcomes following anterior cervical discectomy and fusion with anterior cervical plating. Neurospine 16:618–625
Hollowell JP, Reinartz J, Pintar FA, Morgese V, Maiman DJ (1994) Failure of synthes anterior cervical fixation device by fracture of Morscher screws: a biomechanical study. J Spinal Disord 7:120–125
Huang W-C, Wu J-C (2019) Preservation versus elimination of segmental motion in anterior cervical spine surgery. Neurospine 16:576–578
Hwang C, Bae J-Y, Koo K, Lee JH, Yeom JS, Chang B-S, Lee C-K (2007) A comparative experimental study of allograft and porous hydroxyapatite as bone substitutes. The Journal of The Korean Orthopaedic Association 42
Jae Hyup L, Ul Oh J, Do Hwan J, Bong Soon C, Choon Ki L (2010) Quantitative comparison of novel CaO-SiO2-P2O5-B2O3 glass-ceramics (BGS-7) with hydroxyapatite as bone graft extender in rabbit ilium. Korean Tissue Engineering and Regenerative Medicine 7:540–547
Jain V, Madan A, Thakur M, Thakur A (2018) Functional outcomes of subaxial spine injuries managed with 2-level anterior cervical corpectomy and fusion: a prospective study. Neurospine 15:368–375
Jiya T, Smit T, Deddens J, Mullender M (2009) Posterior lumbar interbody fusion using nonresorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D,L-lactide fusion devices: a prospective, randomized study to assess fusion and clinical outcome. Spine (Phila Pa 1976) 34:233–237
Kim DH, Lee C-H, Ko YS, Yang SH, Kim CH, Park SB, Chung CK (2019) The clinical implications and complications of anterior versus posterior surgery for multilevel cervical ossification of the posterior longitudinal ligament; an updated systematic review and meta-analysis. Neurospine 16:530–541
Kim Y, Lim JY, Yang GH, Seo J-H, Ryu H-S, Kim G (2019) 3D-printed PCL/bioglass (BGS-7) composite scaffolds with high toughness and cell-responses for bone tissue regeneration. J Ind Eng Chem
Kokubo T, Ito S, Huang ZT, Hayashi T, Sakka S, Kitsugi T, Yamamuro T (1990) Ca,P-rich layer formed on high-strength bioactive glass-ceramic A-W. J Biomed Mater Res 24:331–343
Koo K, Hwang C, Lee JH, Chang B-S, Lee C-K (2009) Treatment of bone defects in rabbit tibiae using CaO-SiO2-P2O5-B2O3 bioactive ceramics: radiological, biomechanical, and histological evaluation
Krijnen MR, Mullender MG, Smit TH, Everts V, Wuisman PI (2006) Radiographic, histologic, and chemical evaluation of bioresorbable 70/30 poly-L-lactide-CO-D, L-lactide interbody fusion cages in a goat model. Spine (Phila Pa 1976) 31:1559–1567
Kwon OI, Son DW, Lee SW, Song GS (2016) Comparison of radiologic outcomes of different methods in single-level anterior cervical discectomy and fusion. Korean J Spine 13:91–96
Lawrence BD, Jacobs WB, Norvell DC, Hermsmeyer JT, Chapman JR, Brodke DS (2013) Anterior versus posterior approach for treatment of cervical spondylotic myelopathy: a systematic review. Spine (Phila Pa 1976) 38:S173–S182
Lee JH, Hong KS, Baek HR, Seo JH, Lee KM, Ryu HS, Lee HK (2013) In vivo evaluation of CaO-SiO2-P2O5-B2O3 glass-ceramics coating on Steinman pins. Artif Organs 37:656–662
Lee JH, Kong CB, Yang JJ, Shim HJ, Koo KH, Kim J, Lee CK, Chang BS (2016) Comparison of fusion rate and clinical results between CaO-SiO2-P2O5-B2O3 bioactive glass ceramics spacer with titanium cages in posterior lumbar interbody fusion. Spine J 16:1367–1376
Lee JH, Ryu HS, Seo JH, Chang BS, Lee CK (2010) A 90-day intravenous administration toxicity study of CaO-SiO2-P2O5-B2O3 glass-ceramics (BGS-7) in rat. Drug Chem Toxicol 33:38–47
Lee JH, Ryu HS, Seo JH, Lee DY, Chang BS, Lee CK (2014) Negative effect of rapidly resorbing properties of bioactive glass-ceramics as bone graft substitute in a rabbit lumbar fusion model. Clin Orthop Surg 6:87–95
Lee YS, Kim YB, Park SW (2014) Risk factors for postoperative subsidence of single-level anterior cervical discectomy and fusion: the significance of the preoperative cervical alignment. Spine (Phila Pa 1976) 39:1280–1287
Lied B, Roenning PA, Sundseth J, Helseth E (2010) Anterior cervical discectomy with fusion in patients with cervical disc degeneration: a prospective outcome study of 258 patients (181 fused with autologous bone graft and 77 fused with a PEEK cage). BMC Surg 10:10
Maharaj MM, Phan K, Mobbs RJ (2016) Anterior cervical discectomy and fusion (ACDF) autograft versus graft substitutes: what do patients prefer?-a clinical study. J Spine Surg 2:105–110
Miller LE, Block JE (2011) Safety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery. Spine (Phila Pa 1976) 36:2045–2050
Northrup BE, Vaccaro AR, Rosen JE, Balderston RA, Cotler JM (1995) Occurrence of infection in anterior cervical fusion for spinal cord injury after tracheostomy. Spine (Phila Pa 1976) 20:2449–2453
Oh HS, Shim CS, Kim JS, Lee SH (2013) Clinical and radiological comparison of femur and fibular allografts for the treatment of cervical degenerative disc diseases. J Korean Neurosurg Soc 53:6–12
Ohtsuki C, Kamitakahara M, Miyazaki T (2009) Bioactive ceramic-based materials with designed reactivity for bone tissue regeneration. J R Soc Interface 6(Suppl 3):S349–S360
Patel AA, Spiker WR (2008) Update on the diagnosis and treatment of lumbar nonunions. Seminars in Spine Surgery 20:20–26
Pollard CA (1984) Preliminary validity study of the pain disability index. Percept Mot Skills 59:974
Ramnarain A, Govender S (2008) Fibular allograft and anterior plating for dislocations/fractures of the cervical spine. Indian journal of orthopaedics 42:83–86
Ryken TC, Heary RF, Matz PG, Anderson PA, Groff MW, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Vresilovic EJ, Resnick DK, Joint Section on Disorders of the S, Peripheral Nerves of the American Association of Neurological S, Congress of Neurological S (2009) Techniques for cervical interbody grafting. J Neurosurg Spine 11:203–220
Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2:175–184
Seaman S, Kerezoudis P, Bydon M, Torner JC, Hitchon PW (2017) Titanium vs. polyetheretherketone (PEEK) interbody fusion: meta-analysis and review of the literature. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 44:23–29
Shin JJ (2019) Comparison of adjacent segment degeneration, cervical alignment, and clinical outcomes after one- and multilevel anterior cervical discectomy and fusion. Neurospine 16:589–600
Shriver MF, Lewis DJ, Kshettry VR, Rosenbaum BP, Benzel EC, Mroz TE (2017) Dysphagia rates after anterior cervical diskectomy and fusion: a systematic review and meta-analysis. Global spine journal 7:95–103
Siambanes D, Mather S (1998) Comparison of plain radiographs and CT scans in instrumented posterior lumbar interbody fusion
Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A:607–624
Wilson JRF, Badhiwala JH, Moghaddamjou A, Martin AR, Fehlings MG (2019) Degenerative cervical myelopathy; a review of the latest advances and future directions in management. Neurospine 16:494–505
Yamamuro T, Shikata J, Okumura H, Kitsugi T, Kakutani Y, Matsui T, Kokubo T (1990) Replacement of the lumbar vertebrae of sheep with ceramic prostheses. J Bone Joint Surg Br 72:889–893
Yan D, Wang Z, Deng S, Li J, Soo C (2011) Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients. Arch Orthop Trauma Surg 131:1369–1374
Yang JJ, Yu CH, Chang BS, Yeom JS, Lee JH, Lee CK (2011) Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage. Clin Orthop Surg 3:16–23
Yue WM, Brodner W, Highland TR (2005) Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976) 30:2138–2144
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures were performed in accordance with the ethical standards of the Institutional Review Board of Severance Hospital (approval number 2019-0739-001).
The requirement for informed consent was waived because of the retrospective design of this study.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Kim, H.C., Oh, J.K., Kim, D.S. et al. Comparison of the effectiveness and safety of bioactive glass ceramic to allograft bone for anterior cervical discectomy and fusion with anterior plate fixation. Neurosurg Rev (2020) doi:10.1007/s10143-019-01225-x
- Anterior cervical discectomy and fusion
- Bioactive glass ceramic cage
- Allograft bone
- Fusion rate
- Clinical and radiological outcomes