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 대한정형외과학회 2025 Clinics in Orthopedic Surgery Vol.17 No.2

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.

OP-1 이 첨가된 Lyophilized Cartilage Allografts를 이용한 관절연골결손의 재생

신영진,김태준 大韓成形外科學會 2000 Archives of Plastic Surgery Vol.27 No.2

Joint cartilage defects do not heal and lead to post traumatic arthritis or degenerative joint diseases. The clinical problem is that so far, we have been unable to induce true cartilage healing and regeneration. Experimental attempts at repairing joint cartilage defects with various means have usually led to the formation of cartilage-like fibro-hyaline scars. We have recently shown that treatment of lyophilized allografts with recombinant osteoinductive protein-1 (OP-1 also known as BMP 7) induced the regeneration of articular cartilage over the head of lyophilized hemijoint allografts. A standardized 3 mm circular defect was created on the articular surface of the knee joint of 12 NZW rabbits. The defect was into carried as full thickness down to subchondral bone. In a blinded and randomized fashion, the rabbits were divided into four groups. In group 1(n=4), the ulcer was left untreated; in group Ⅱ(n=3), the ulcer was reconstructed with a 3 mm disk of lyophilized cartilage allograft; in group Ⅲ(n=2), the allograft used was pre-treated with low dose (20㎍) OP-1, and in group 1V(n=3), the allograft used was pre-treated with high dose(100㎍) OP-1. The range of motion was normal in all groups. The gross appearance of the untreated defect was still depressed and appeared like a big crater. The lyophilized allograft has a level surface which was not smooth. In high dose OP-1 group, the defect was healed much better than the lower dose treated OP-1 group. Under the histologic examination, untreated ulcer group never heals to the cartilage of around defect, a fissure always remains. Lyophilized allograft and low dose OP-1 treated lyophilized allograft groups seem to inhibit healing and there is fibrous scar in ulcer. In the high dose OP-1 treated lyophilized allograft group, new cartilage heals very well all around of the defect margin without fissure. The cartilage has a normal sequence of cellular maturation. In conclusion, in this study of full thickness joint cartilage defects, we confirmed finding in the literature that defect heals with cartilage like tissue which does not fuse with the surrounding cartilage. We found that lyophilize allograft prevents healing of defect, while lyophilized allograft treated with high dose (100㎍) OP-1 seems to induce regeneration of articular cartilage that heals very well to the surrounding defect without any crack or fissure.

단분절 후방 요추체간 유합술에서 Cage 내고정군과 자가 골수 혼합 동종골군의 방사선학적 및 임상 결과 비교

임채현,최용수,김대희,안상호 대한척추외과학회 2012 대한척추외과학회지 Vol.19 No.4

Study Design: A retrospective study. Objectives: To compare the radiological and clinical results between cage and cancellous allograft mixed with bone marrow for monosegmental instrumented posterior lumbar interbody fusion (PLIF). Summary of the Literature Review: Allograft has potential problems, such as delayed union. Autologous bone marrow provides for improving the capability of bone induction with allograft. There are rare reports on PLIF using allograft mixed with autologous bone marrow. Materials and Methods: Monosegmental instrumented PLIF was performed on 51 patients who had lumbar degenerative disease, cage for 28 patients (cage group) and allograft mixed with bone marrow for 23 patients (allograft group). The clinical and radiological results in each group were compared. Results: The mean follow-up was 45 (30 - 111) months. At the final follow up, there was no significant difference between the cage group and the allograft group in the Korean Version Oswestry Disability Index (p=0.72) and Visual Analogue Score for back pain (p=0.54)and radiating pain to the leg (p=0.26). The radiological fusion rate was 92.8% in the cage group, and 82.6% in the allograft group (p=0.02). At the last follow up, disc height was decreased to 1.5±0.8 mm of the cage group, and 3.0±1.5 mm of the allograft group (p=0.0001). Conclusions: PLIF using cancellous allograft mixed bone marrow has low fusion rate contrast to good clinical results. It is necessary to take a careful selection of the allograft mixed bone marrow for PLIF. 연구계획: 후향적 연구목적: 퇴행성 요추 질환에서 단분절 추체간 유합술을 위해 cage 내고정술과 자가 골수 혼합 해면 동종골 삽입술의 방사선학적 및 임상 결과를 비교 하였다. 선행문헌의 요약: 동종골의 문제로 유합 기간 지연이 지적되고 있다. 자가 골수 이식은 신생골 형성에 우수한 것으로 알려져 있어 요추 질환에서 추체간유합술을 위해 자가 골수 혼합 동종골 삽입술 결과 보고는 드물다. 대상 및 방법: 퇴행성 요추 질환으로 단분절 추체간 유합술을 시행하였던 51예를 대상으로 하였다. Cage를 이용한 28예를 Cage 군으로, cage없이 해면 동종골과 자가 골수를 혼합하여 후방 요추체간 유합술을 시행 받은 23예를 동종골 군으로 분류하였다. 두 군간의 임상적 및 방사선학적 결과를 비교분석하였다. 결과: 45(30-111)개월 추적 조사되었다. 최종 추시상 한국어판 장애지수 (p=0.72), 요통 (p=0.54)과 하지 방사통 (p=0.26)의 시각통증지수에서 Cage 군과 동종골 군간 차이를 보이지 않았다. 방사선학적 추체간 유합율은 Cage군 92.8%, 동종골군이 82.6%로 동종골군의 유합률이 낮았다(p=0.02). 최종 추시 상 추체간 높이가 Cage군 평균1.5±0.8mm, 동종골군 평균 3.0±1.5mm 소실되어 Cage군이 추체간 높이 유지에 양호한 결과를 얻었다(p=0.0001). 결론: 요추 후방 추체간 유합술에서 자가골수 혼합 해면 동종골은 임상적으로 양호한 결과를 얻었으나 방사선학적으로 추체간 유합에 불량한 결과로자가 골수 혼합 해면 동종골 이식술의 요추 후방 추체간 유합술 적용에 신중한 선택이 필요하리라 사료된다.

Small Size Autograft versus Large Size Allograft in Anterior Cruciate Ligament Reconstruction

Alper Kurtoğlu,Betül Başar,Gökhan Başar,Ömer Gezginaslan,Hakan Başar 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.1

Background: A small autograft diameter negatively affects functional outcomes, knee stability, and the risk of rerupture after anterior cruciate ligament (ACL) reconstruction, whereas the strength of allograft decreases over time. Therefore, it is not clear whether the use of smaller autografts or the use of larger allografts in ACL yields better results. The aim of this study was to compare the outcome of smaller autografts and larger allografts for ACL reconstruction. Methods: Fifty-one patients who underwent ACL reconstruction with hamstring tendon autografts (size ≤ 8 mm) and 21 patients who underwent ACL reconstruction with allografts (size ≥ 10 mm) were included in our study. All patients underwent the same aggressive early postoperative rehabilitation program. There were no significant differences between the autograft and allograft groups regarding the preoperative patient age, sex, time from injury to surgery, and average follow-up time. Results: The mean diameter of the 4-stranded hamstring tendon grafts used as autografts was 7.48 ± 0.33 mm and the mean diameter of the allografts was 10.76 ± 0.67 mm. According to specific tests for the ACL (anterior drawer, Lachman, and pivot shift) and clinical evaluation tests (Lysholm knee scoring scale and International Knee Documentation Committee questionnaire), the final follow-up results were significantly better than the preoperative status in both autograft and allograft ACL reconstruction groups. Therefore, there were no significant differences between the autograft and allograft groups preoperatively and at the final follow-up. Conclusions: The large size of the graft in ACL reconstruction has been reported to affect results positively. However, in our study, we could not find any significant differences between the smaller size autografts and larger size allografts in terms of inadequacy, rerupture, and final follow-up functional results. Although allografts were significantly larger than autografts, we did not have the positive effect of larger size grafts. Smaller size autografts were as effective as the larger size allografts.

신이식 후 면역반응의 이해 - 1부. 이식 거부 반응의 기전 -

강희경,Kang, Hee-Gyung 대한소아신장학회 2008 Childhood kidney diseases Vol.12 No.1

Kidney allograft transplantation is the most effective method of renal replacement for end stage renal disease patients. Still, it is another kind of 'disease', requiring immunosuppression to keep the allograft from rejection(allograft immune reaction). Immune system of the allograft recipient recognizes the graft as a 'pathogen (foreign or danger)', and the allograft-recognizing commanderin-chief of adaptive immune system, T cell, recruits all the components of immune system for attacking the graft. Proper activation and proliferation of T cell require signals from recognizing proper epitope(processed antigen by antigen presenting cell) via T cell receptor, costimulatory stimuli, and cytokines(IL-2). Thus, most of the immunosuppressive agents suppress the process of T cell activation and proliferation.

생체에서 채취한 동종골의 세균 오염

강용구(Yong-Koo Kang),이한용(Han-Yong Lee),유기원(Kee-Won Rhyu),김건형(Kun-Hyung Kim),허성우(Sung-Woo Huh),이주엽(Joo-Yup Lee) 대한정형외과학회 2006 대한정형외과학회지 Vol.41 No.1

동종동맥판 혈관내피세포의 생육성 평가에 관한 연구

임창영,홍은경 大韓胸部外科學會 1997 Journal of Chest Surgery (J Chest Surg) Vol.30 No.6

Effect of platelet-rich plasma in Achilles tendon allograft in rabbits

Seok-Hong Park,Dong-Yub Kim,Won-Jae Lee,Min Jang,Seong Mok Jeong,Sae-Kwang Ku,Young-Sam Kwon,Sungho Yun The Korean Society of Veterinary Science 2024 Journal of Veterinary Science Vol.25 No.2

Background: Achilles tendon is composed of dense connective tissue and is one of the largest tendons in the body. In veterinary medicine, acute ruptures are associated with impact injury or sharp trauma. Healing of the ruptured tendon is challenging because of poor blood and nerve supply as well as the residual cell population. Platelet-rich plasma (PRP) contains numerous bioactive agents and growth factors and has been utilized to promote healing in bone, soft tissue, and tendons. Objective: The purpose of this study was to evaluate the healing effect of PRP injected into the surrounding fascia of the Achilles tendon after allograft in rabbits. Methods: Donor rabbits (n = 8) were anesthetized and 16 lateral gastrocnemius tendons were fully transected bilaterally. Transected tendons were decellularized and stored at -80℃ prior to allograft. The allograft was placed on the partially transected medial gastrocnemius tendon in the left hindlimb of 16 rabbits. The allograft PRP group (n = 8) had 0.3 mL of PRP administered in the tendon and the allograft control group (n = 8) did not receive any treatment. After 8 weeks, rabbits were euthanatized and allograft tendons were transected for macroscopic, biomechanical, and histological assessment. Results: The allograft PRP group exhibited superior macroscopic assessment scores, greater tensile strength, and a histologically enhanced healing process compared to those in the allograft control group. Conclusions: Our results suggest administration of PRP on an allograft tendon has a positive effect on the healing process in a ruptured Achilles tendon.

자가 골-슬개건-골과 동종 아킬레스 건을 이용한 전방십자인대 재건술의 임상결과 비교

최호림(Ho-Rim Choi),최상욱(Sang-Wook Choi),권세원(Sai-Won Kwon),박종석(Jong-Seok Park),이병일(Byung-Ill Lee) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.5

초냉동 보관된 백서의 동종 기관 이식편의 대망 내 이식에 따른 조직 생육성 및 혈관 형성

김용희,박승일,김동관,김규래 대한흉부외과학회 2004 Journal of Chest Surgery Vol.37 No.8

Background: Using the neovascularizing properties of the omentum, we studied the viability and vascularity of the cryopreserved rat tracheal allografts with omental implantation. Material and Method: The cryopreserved tracheal allografts of eight-week old male Sprague Dawley rats were implanted into the omentum. The rats were divided into the four groups according to the duration of cryopreservation and of omental implantation. We examined the tracheal allografts histologically for viability of cartilages, inflammation and fibrosis of smooth muscle and connective tissue, and degree of vascularity. Result: The degree of inflammation in the smooth muscle and the connective tissue of the tracheal allografts was not statistically related to neither the duration of cryopreservation or of omental implantation. The tracheal cartilages of the tracheal allografts were found to be severely calcified in all cases. Significant difference in vascularity was found between the groups I and II (p<0.05). And a sufficient vascularity in the intercartilaginous space was observed in the midportion of the the tracheal allografts as well as both ends. Conclusion: In conclusion, the omental implantation for 2 weeks could establish a sufficient vascularity in the intercartilaginous spaces for maintaining the viability of the tracheal allografts. This study might provide a possibility of the sequential tracheal allotransplantation after omental implantation. 배경: 대망의 가장 중요한 성질 중 하나인 혈관 형성 촉진 기능을 이용하여 초냉동 보관된 기관 이식편의 대망 내 이식이 기관 이식편의 생육성이나 혈관 형성에 미치는 영향을 연구하고자 한다. 대상 및 방법: 8주령의 Sprague Dawley rat 수컷의 초냉동 보관된 기관 이식편을 백서의 복강 내 대망에 이식하였다. 연구군은 냉동 보관기간과 대망 내 이식기간에 따라 4개의 군으로 분류하였다(n=52). 이식된 기관 이식편을 획득하여 기관 평활근 및 주변 결합 조직의 섬유화 및 염증 정도, 기관 연골의 석회화 정도, 기관 내 상피세포의 변화 및 연골간 간격에서의 혈관 형성 정도 등을 검사하였다. 결과: 기관 평활근의 염증 정도는 냉동 보관기간이나 대망 내 이식기간에 따라 유의한 차이를 보이지 않았고, 기관 연골의 석회화 정도는 냉동 보관기간과 상관없이 대부분 심하게 진행되어 있었다. 혈관 형성은 기관 이식편의 양 끝뿐만 아니라 중간 부위에서도 충분히 이루어져 있었다. 결론: 초냉동 보관된 백서의 장분절 기관 이식편을 2주간 대망 내 이식을 시행한 결과 기관 이식편의 조직 생육성이 적절히 유지되면서 새로운 혈관이 형성되었다. 향후 동종 기관 이식 시 초냉동 보관된 기관 이식편을 대망 내 이식하여 새로운 혈관이 형성된 후 단계적으로 기관 이식을 시행하는 데 도움이 될 수 있다고 생각한다.