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CORAL CHIP ALLOGRAFT FUSION FOR ACD
ORIGINAL WORK
The surgery for one level soft cervical herniated disc like many procedures in neurosurgery has changed over the years from posterior to anterior approaches with and without fusion. Fusion can be performed with autograft and allograft depending upon the patients and surgeon preference. Even the choice of bone to use in fusion is variable. The rate of fusion has been shown to be 92% for allograft fibular strut fusion and 92% for autologous fusion (10) at one year but occurred less frequently in allograft at 3 months. 48 patients under going outpatient anterior cervical microdiscectomy with allograft fibular strut fusion have been studied retrospectively. 18 patients have had the addition of micropore coral chips the others fibular strut without additional material. Coral chips are synthetic hydroxyapatite derived from marine coral. Follow up lateral cervical spine xray demonstrated that there was 60% or greater fusion both superior and inferior at the graft site at two weeks in 83% of the patients receiving coral chips as compared to 33% not receiving additional material. At six weeks post operation the coral chip group were 100% fused using the criteria above and the others 80% fused. Additional studies using coral paste, a coral block alone and comparison of graft collapse need to be investigated.
INTRODUCTION
Horsley in 1895 successfully decompressed the cervical spine and brought the surgical treatment of cervical disc disease and spondylosis into the modem age. Cervical radiculopathy can be caused by soft herniated discs or spondylitic spurs, which can compress centrally or laterally. Patients with symptomatic disc disease can have limited symptoms, although, one-fourth to one-third may have persistent moderate to severe pain (7,9,11).
The approach for one level herniated discs can either be anterior or posterior. The posterior approach decompresses the cervical cord and roots from posterior osteophytes or hypertrophic ligamentum flavum. This approach of course does not allow easy access to the ventral ruptured disc or osteophytes and can lead to increased mobility, stimulating further bony spur formation. The anterior approach with fusion directly decompresses the spine and nerve roots of the discs or ventral osteophytes, and allows the enlargement of the neural foramen through distraction of the disc space. A solid fusion diminishes
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