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

Current Concepts Review - Interbody Fusion Cages in Reconstructive Operations on the Spine*

by PAUL C. MCAFEE

J Bone Joint Surg AmVolume 81(6):859-80

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;81:859-80


Fig. 1-B Bar graph showing the intracage pressure measurements for the ten cage constructs.



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 ...



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 ...



Fig. 3-A Radiographs demonstrating the paradox regarding a solid fusion compared with a so-called functional arthrodesis.



Fig. 3-B Radiographs demonstrating the paradox regarding a solid fusion compared with a so-called functional arthrodesis.



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.



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.



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.



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.



Fig. 5-B: Magnetic resonance image made within one month after the operation, showing pyogenic vertebral osteomyelitis.



Fig. 5-C Radiograph made after six weeks of intravenous administration of antibiotics.



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.



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.



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.



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.



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...



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...



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.



Fig. 7-B At a higher magnification, the section demonstrates the trabecular architecture within the BAK device (x 10).



Fig. 7-C Midsagittal microradiograph, the so-called gold standard for documenting fusion.



Fig. 8 Bar graph showing lateral bending stiffnesses of spinal segments from sheep four months after operative treatment.



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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